Pediheart: Pediatric Cardiology Today Robert Pass

This week we review a novel multivariable model used to predict mortality in the repaired tetralogy of Fallot patient. Can this model identify who amongst the repaired TOF patients is at risk for death in the coming years? What are the most important inputs to this model? Why does the use of a validation cohort provide greater strength to this model and is there still room for improvement in the model? Can the data in this work help inform decisions regarding pulmonary valve replacement timing? These are amongst the questions posed to the senior author of this work, Cardiologist-in-Chief at Boston Children's Hospital and Professor of Pediatrics at Harvard University, Dr. Tal Geva. 

Novel risk calculator: https://github.com/rTOF-INDICATOR/MORTALITY-RISK-Score

doi: 10.1161/JAHA.123.034871. Epub 2024 Jun 11.

This week we listen in to a wonderful roundtable discussion with 3 of the pioneers in the world of pediatric electrophysiology, namely Dr. John Triedman, Dr. J. Philip Saul and Dr. Edward P. Walsh. All three were 'there at the beginning' and share their memories of how they helped to shape the field of pediatric EP. How did Drs. Walsh and Saul choose to proceed with EP training in a pre-ablation and pre-pediatric EP training era? How did all three decide to start a fellowship program to train the next generation of EP doctors? What sort of 'technology' existed to perform ablations in Boston in the early 1990's and how did these experts come to be the first to perform an RF ablation in any human in Boston? How does the field differ today in comparison to its origins? Amongst their many professional accomplishments, what does each 'guru' view as their greatest professional achievement? These are amongst the many questions posed during a wonderful symposium that was held in Boston on 5/16/24 to celebrate both the 35th anniversary of the EP training program at Boston Children's as well as the milestone birthday of the program's founder, Dr. Edward Walsh. 

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