Reintervention rates after bioprosthetic pulmonary valve replacement in patients younger than 30 years of age: A multicenter analysis

Baird, Christopher W.; Chávez, Mariana; Sleeper, Lynn A.; Borisuk, Michele; Bacha, Emile A.; Burchill, Luke J.; Guleserian, Kristine J.; Ilbawi, Michel N.; Nguyen, Khanh; Razzouk, Anees J.; Shinkawa, Takeshi; Lü, Minmin; Fuller, Stephanie

doi:10.1016/j.jtcvs.2020.06.157

Cited by 27 publications

(13 citation statements)

References 34 publications

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“…Thirty-three patients (55% female) with a median age of 11 [7,13] years and median weight of 32 [23,44] kg underwent SPVR from January 2017 through December 2020 (Table 1). The most common underlying CHD diagnoses were Tetralogy of Fallot (n = 20, 61%) followed by congenital pulmonary stenosis or pulmonary atresia (n = 4, 12%).…”

Section: Resultsmentioning

confidence: 99%

“…Upon review of our center's experience with SPVR after implementation of a CP, we demonstrated no 30-day complications, readmissions, reinterventions, or mortalities and had an associated LOS far lower than previously reported benchmarks. [21][22][23][24] The SPVR care pathway has several unique components that begin in the preoperative planning stage and continue through surgery to hospital discharge. Our patients undergo extensive preoperative assessment and education.…”

Section: Commentmentioning

confidence: 99%

“…The result of our efforts, in addition to maintaining excellent short-term patient outcomes, is an overall LOS of 2 [2,2] days -considerably shorter than prior benchmarks demonstrating medians of 4 to 6 days (Figure 1). [21][22][23][24] For two of these reported studies, our total LOS was equivalent to just their reported ICU LOS (Figure 1). Therefore, despite discharging patients directly from our CICU, our ICU LOS was equivalent to prior benchmarks and our overall LOS was less.…”

Section: Commentmentioning

confidence: 99%

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Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway

Katz

Lion

Martens

et al. 2022

World J Pediatr Congenit Heart Surg

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Background Standardization of perioperative care can reduce resource utilization while improving patient outcomes. We sought to describe our outcomes after the implementation of a perioperative clinical pathway for pediatric patients undergoing elective surgical pulmonary valve replacement and compare these results to previously published national benchmarks. Methods A retrospective single-center descriptive study was conducted of all pediatric patients who underwent surgical pulmonary valve replacement from 2017 through 2020, after the implementation of a clinical pathway. Outcomes included hospital length of stay and 30-day reintervention, readmission, and mortality. Results Thirty-three patients (55% female, median age 11 [7, 13] years, 32 [23, 44] kg) were included in the study. Most common diagnosis and indication for surgery was Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%). All patients had prior cardiac surgery. Median hospital length of stay was 2 [2, 2] days, and longest length of stay was three days. There were no 30-day readmissions, reinterventions, or mortalities. Median follow-up time was 19 [9, 31] months. Conclusions Formalization of a perioperative surgical pulmonary valve replacement clinical pathway can safely promote short hospital length of stay without any short-term readmissions or reinterventions, especially when compared with previously published benchmarks. Such formalization enables the dissemination of best practices to other institutions to reduce hospital length of stay and limit costs.

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Section: Resultsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway

Katz

Lion

Martens

et al. 2022

World J Pediatr Congenit Heart Surg

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“…20 Most surgically placed pulmonary valves last between 4 and 15 years before requiring replacement, either due to valve dysfunction or patient growth. 46 Transcatheter pulmonary valve replacement utilises a percutaneous approach and requires a shorter hospital stay, typically under 24 hours. Though data are relative sparse and still evolving, there has been question as to whether some transcatheter valves have a higher risk of bacterial endocarditis, approaching 2.5% per patient-year.…”

Section: Pulmonary Valve Replacementmentioning

confidence: 99%

Paediatrician’s guide to post-operative care for biventricular CHD: a review

et al. 2022

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Importance: Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients. Observations: The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation. Conclusions and relevance: Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.

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“…Bioprostheses and homografts are susceptible to immune responses and structural valve deterioration [3]. Unfortunately, these poor outcomes tend to manifest earlier for younger patients, forcing them to undergo multiple operations throughout their lifetime [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

From Scan to Simulation—A Novel Workflow for Developing Bioinspired Heart Valves

Lee

Farajikhah

Crago

et al. 2022

Journal of Biomechanical Engineering

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Current heart valve replacements lack durability and sustained performance, especially in paediatric patients. In part, these problems may be attributed to the materials chosen for these constructs, but an important contributing factor is the design of the valve, as this dictates haemodynamic performance and impacts leaflet stresses which may accelerate structural valve deterioration. Most current era bioprosthetic valves adhere to a fundamental design where flat leaflets are supported by stent posts, secured to a sewing ring. This overall design strategy is effective, but functionality and durability may be improved by incorporating features of the native valve geometry. This paper presents a novel workflow for developing and analysing bioinspired valve designs computationally. The leaflet curvature was defined using a mathematical equation that was derived from the 3D model of a native sheep pulmonary valve obtained via micro-computed tomography. Finite Element Analysis was used to screen the various valve designs proposed in this study by assessing the effect of leaflet thickness, Young's modulus, and height/curvature on snap-through, Geometric Orifice Area (GOA) and the stress in the leaflets. This workflow demonstrated benefits for valve designs with leaflet thicknesses between 0.1-0.3 mm, Young's moduli less than 50 MPa, and elongated leaflets with greater curvatures. The proposed workflow brings substantial efficiency gains, minimising manufacturing and animal testing during iterative improvements, and offers a bridge between in vitro and more complex in silico studies in the future.

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Reintervention rates after bioprosthetic pulmonary valve replacement in patients younger than 30 years of age: A multicenter analysis

Cited by 27 publications

References 34 publications

Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway

Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway

Paediatrician’s guide to post-operative care for biventricular CHD: a review

From Scan to Simulation—A Novel Workflow for Developing Bioinspired Heart Valves

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