Pediheart: Pediatric Cardiology Today Robert Pass

This week we review a recent editorial commentary from multiple congenital heart surgical leaders in the US today. The topic of their expert opinion piece is the concept of public reporting of results and their 'amplification' through organizations such as US News and World Report, to name one. How has the use of the database from STS been sometimes misinterpreted through public reporting or ranking systems? What was the initial intent of the STS database and how does the present usage of these data differ from the initial intent? Do STS risk adjustment models capture all aspects of risk for patients undergoing surgery and how do deficiencies in this result in unfair 'rankings' of programs? Can we 'take control' of our data and interpret it more clearly and accurately for the public and reduce misusage or misinterpretation of the data? How can public reporting result in improved outcomes? How can 'gaming' of the system be reduced? Dr. Emile Bacha, Professor of Surgery at Columbia University shares his deep insights into a complex and challenging topic. 

DOI: 10.1016/j.jtcvs.2023.03.022

In this week's podcast, we discuss a work that tries to challenge convention when we review a recent work from the team at Emory University about anticoagulation following left sided ablation of SVT in children. A short course of aspirin is commonly prescribed in this setting but what is the evidence for this? How do patients who receive aspirin fare vs. those who do not? Are there some patients in which aspirin might be more 'useful' than others? Is there adequate equipoise to consider a multicenter trial? Is that even necessary? Joining us to discuss this and more about this topic is Dr. Vincent Palmieri, senior electrophysiology fellow at Children's Healthcare of Atlanta. 

doi: 10.1016/j.hrthm.2024.01.004.

This week we review a recent large scale, multicenter study of the Pediatric Cardiac Intensive Care Society Investigators on outcomes of pulmonary atresia with intact ventricular septum (PA/IVS) in the present era. How are patients faring in the present era in comparison to the prior 1-2 decades? What are the most important factors to account for improvements observed in survival? Are there subtypes of PA/IVS that warrant early referral to heart transplantation? What is the best predictor of a better outcome and what percentage of PA/IVS patients ultimately have a 2 ventricle repair? Where are the areas for improvement in the coming decade to improve upon these already, improved outcomes? These are amongst the many questions reviewed in this week's episode with the first author, Dr. Ilias Iliopoulos, who is the director of pediatric cardiac critical care at Inova LJ Murphy Children's Hospital.

https://doi.org/10.1007/s00246-022-02954-5

In this replay of our milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace.

doi: 10.1007/s00134-004-2504-1

This week we delve into the world of interventional cardiology and congenital heart surgery when we review a recent report from the team at Toronto Sick Children's Hospital about their experience with interventions in the pulmonary arteries following the arterial switch operation. How often are branch or main pulmonary artery narrowings serious enough to warrant intervention? What degree of RV pressure should warrant a cath or intervention? How commonly did simple balloon dilation result in a meaningful degree of reduction in pulmonary artery obstruction and/or RV pressure? How commonly were complications observed? These are amongst the questions reviewed this week with the work's first author, senior cardiology fellow at the University of Toronto, Dr. Michael N. Gritti.

https://doi.org/10.1007/s00246-024-03408-w

This week we review a report from Italy regarding the observation of RA disk thrombus formation in some patients following GORE Cardioform ASD closure. How common is this complication seen and are there some patient or device characteristics that would be considered higher risk for this complication? How does this information square with the Assured trial data? Why might there be differences between the two data sources? We speak with Associate Professor of Pediatrics at Kravis Children's Hospital at Mount Sinai, Dr. Barry Love who is also Director of the Congenital Cardiac Catheterization Laboratory at Mount Sinai Hospital. 

 https://doi.org/10.1002/ccd.31002