Comparison of inhospital outcomes of pediatric heart transplantation between single ventricle congenital heart disease and cardiomyopathy.

Data investigating the impact of household income and other factors on SV patient status-post-Fontan palliation after heart transplantation are lacking. We aim to evaluate factors affecting outcomes after OHT in this population. The PHIS database was interrogated for either SV or myocarditis/primary CM who were 4 years or older who underwent a single OHT. There were 1599 patients with a median age of 13.2 years (IQR: 9.3-16.1). Total hospital costs were significantly higher in the SV group ($408 000 vs $294 000, P < 0.0001), but as median household income increased, the risk of inhospital mortality, post-transplant LOS, and LOS-adjusted total hospital costs all decreased. The risk of inhospital mortality increased 6.5% per 1 year of age increase at the time of transplant. Patients in the SV group had significantly more diagnoses than those in the CM group (21 vs 15, P < 0.0001) and had longer total hospital LOSs as a result of longer post-transplant courses (25 days vs 15, P < 0.0001). Increased median household income and younger age are associated with decreased resource utilization and improved inhospital mortality in SV CHD patients who undergo OHT. In conclusion, earlier consideration of OHT in this population, coupled with improved selection criteria, may increase survival in this population.

An Empirically Derived Pediatric Cardiac Inotrope Score Associated With Pediatric Heart Surgery.

We aimed to empirically derive an inotrope score to predict real-time outcomes using the doses of inotropes after pediatric cardiac surgery. The outcomes evaluated included in-hospital mortality, prolonged hospital length of stay, and composite poor outcome (mortality or prolonged hospital length of stay). The study population included patients <18 years of age undergoing heart operations (with or without cardiopulmonary bypass) of varying complexity. To create this novel pediatric cardiac inotrope score (PCIS), we collected the data on the highest doses of 4 commonly used inotropes (epinephrine, norepinephrine, dopamine, and milrinone) in the first 24 hours after heart operation. We employed a hierarchical framework by representing discrete probability models with continuous latent variables that depended on the dosage of drugs for a particular patient. We used Bayesian conditional probit regression to model the effects of the inotropes on the mean of the latent variables. We then used Markov chain Monte Carlo simulations for simulating posterior samples to create a score function for each of the study outcomes. The training dataset utilized 1030 patients to make the scientific model. An online calculator for the tool can be accessed at https://soipredictiontool.shinyapps.io/InotropeScoreApp. The newly proposed empiric PCIS demonstrated a high degree of discrimination for predicting study outcomes in children undergoing heart operations. The newly proposed empiric PCIS provides a novel measure to predict real-time outcomes using the doses of inotropes among children undergoing heart operations of varying complexity.

A prognostic tool to predict outcomes in children undergoing the Norwood operation.

OBJECTIVES: To create and validate a prediction model to assess outcomes associated with the Norwood operation. METHODS: The public-use dataset from a multicenter, prospective, randomized single-ventricle reconstruction trial was used to create this novel prediction tool. A Bayesian lasso logistic regression model was used for variable selection. We used a hierarchical framework by representing discrete probability models with continuous latent variables that depended on the risk factors for a particular patient. Bayesian conditional probit regression and Markov chain Monte Carlo simulations were then used to estimate the effects of the predictors on the means of these latent variables to create a score function for each of the study outcomes. We also devised a method to calculate the risk of outcomes associated with the Norwood operation before the actual heart operation. The 2 study outcomes evaluated were in-hospital mortality and composite poor outcome. RESULTS: The training dataset used 520 patients to generate the prediction model. The model included patient demographics, baseline characteristics, cardiac diagnosis, operation details, site volume, and surgeon experience. An online calculator for the tool can be accessed at https://soipredictiontool.shinyapps.io/NorwoodScoreApp/. Model validation was performed on 520 observations using an internal 10-fold cross-validation approach. The prediction model had an area under the curve of 0.77 for mortality and 0.72 for composite poor outcome on the validation dataset. CONCLUSIONS: Our new prognostic tool is a promising first step in creating real-time risk stratification in children undergoing a Norwood operation; this tool will be beneficial for the purposes of benchmarking, family counseling, and research.

Alternative repair strategies for ductal-dependent tetralogy of fallot and short-term postoperative outcomes, a multicenter analysis.

Our aim was to evaluate postoperative morbidity and mortality following initial intervention, comparing primary repair versus palliative shunt in the setting of ductal-dependent tetralogy of Fallot. When neonatal surgical intervention is required, controversy and cross-center variability exists with regard to surgical strategy. The multicenter Pediatric Health Information System database was queried to identify patients with TOF and ductal-dependent physiology, excluding pulmonary atresia. Eight hundred forty-five patients were included-349 (41.3%) underwent primary complete repair, while 496 (58.7%) underwent initial palliation. Palliated patients had significantly higher comorbid diagnoses of genetic syndrome and coronary artery anomalies. Primary complete repair patients had significantly increased morbidity across a number of variables compared to shunt palliation, but mortality rate was equal (6%). Second-stage complete repair was analyzed for 285 of palliated patients, with median inter-stage duration of 231 days (175-322 days). In comparison to primary complete repairs, second-stage repairs had significantly decreased morbidity and mortality. However, cumulative morbidity was higher for the staged patients. Median adjusted billed charges were lower for primary complete repair ($363,554) compared to staged repair ($428,109). For ductal-dependent TOF, there is no difference in postoperative mortality following the initial surgery (6%) whether management involves primary repair or palliative shunt. Although delaying complete repair by performing a palliative shunt is associated with a shift of much of the morbidity burden to outside of the newborn period, there is greater total postoperative morbidity and resource utilization associated with the staged approach.

Documenting the need for nutrition and health intervention for middle-aged and older adults in the Lower Mississippi Delta region.

Multiple demographic, health, and environmental factors may influence the overall quality of diets among rural middle-aged and older adults. This project compared the diet quality of participants in Foods of Our Delta Survey (FOODS 2000) who were aged 55 years and older with national data. The data were assessed using 24-hour dietary recall methodology and a modified version of the United States Department of Agriculture Healthy Eating Index (HEI) that excluded the sodium component. The mean total Modified Healthy Eating Index (MHEI) study score was significantly lower than their counterparts from the national survey (61.0 +/- 0.68 vs. 65.6 +/- 3.65, P < 0.0001). Race and educational attainment were associated with higher MHEI scores. This study emphasized a critical need for implementing nutrition and health interventions in rural communities with special attention to subpopulations at risk.