Adding the Missing Link-Integration of Anesthesia and Perfusion Variables into Europe's Largest Congenital Cardiac Surgery Outcomes Database: Methods and First List of Candidate Variables by an ECHSA-EACTAIC-EBCP Collaboration.

The European Congenital Heart Surgeons Association (ECHSA) Congenital Database (CD) is the second largest clinical pediatric and congenital cardiac surgical database in the world and the largest in Europe, where various smaller national or regional databases exist. Despite the dramatic increase in interventional cardiology procedures over recent years, only scattered national or regional databases of such procedures exist in Europe. Most importantly, no congenital cardiac database exists in the world that seamlessly combines both surgical and interventional cardiology data on an international level; therefore, the outcomes of surgical and interventional procedures performed on the same or similar patients cannot easily be tracked, assessed, and analyzed. In order to fill this important gap in our capability to gather and analyze information on our common patients, ECHSA and The Association for European Paediatric and Congenital Cardiology (AEPC) have embarked on a collaborative effort to expand the ECHSA-CD with a new module designed to capture data about interventional cardiology procedures. The purpose of this manuscript is to describe the concept, the structure, and the function of the new AEPC Interventional Cardiology Part of the ECHSA-CD, as well as the potentially valuable synergies provided by the shared interventional and surgical analyses of outcomes of patients. The new AEPC Interventional Cardiology Part of the ECHSA-CD will allow centers to have access to robust surgical and transcatheter outcome data from their own center, as well as robust national and international aggregate outcome data for benchmarking. Each contributing center or department will have access to their own data, as well as aggregate data from the AEPC Interventional Cardiology Part of the ECHSA-CD. The new AEPC Interventional Cardiology Part of the ECHSA-CD will allow cardiology centers to have access to aggregate cardiology data, just as surgical centers already have access to aggregate surgical data. Comparison of surgical and catheter interventional outcomes could potentially strengthen decision processes. A study of the wealth of information collected in the database could potentially also contribute toward improved early and late survival, as well as enhanced quality of life of patients with pediatric and/or congenital heart disease treated with surgery and interventional cardiac catheterization across Europe and the world.

The European Congenital Heart Surgeons Association (ECHSA) Congenital Database (CD) is the second largest clinical pediatric and congenital cardiac surgical database in the world and the largest in Europe, where various smaller national or regional databases exist. Despite the dramatic increase in interventional cardiology procedures over recent years, only scattered national or regional databases of such procedures exist in Europe. Most importantly, no congenital cardiac database exists in the world that seamlessly combines both surgical and interventional cardiology data on an international level; therefore, the outcomes of surgical and interventional procedures performed on the same or similar patients cannot easily be tracked, assessed, and analyzed. In order to fill this important gap in our capability to gather and analyze information on our common patients, ECHSA and The Association for European Paediatric and Congenital Cardiology (AEPC) have embarked on a collaborative effort to expand the ECHSA-CD with a new module designed to capture data about interventional cardiology procedures. The purpose of this manuscript is to describe the concept, the structure, and the function of the new AEPC Interventional Cardiology Part of the ECHSA-CD, as well as the potentially valuable synergies provided by the shared interventional and surgical analyses of outcomes of patients. The new AEPC Interventional Cardiology Part of the ECHSA-CD will allow centers to have access to robust surgical and transcatheter outcome data from their own center, as well as robust national and international aggregate outcome data for benchmarking. Each contributing center or department will have access to their own data, as well as aggregate data from the AEPC Interventional Cardiology Part of the ECHSA-CD. The new AEPC Interventional Cardiology Part of the ECHSA-CD will allow cardiology centers to have access to aggregate cardiology data, just as surgical centers already have access to aggregate surgical data. Comparison of surgical and catheter interventional outcomes could potentially strengthen decision processes. A study of the wealth of information collected in the database could potentially also contribute toward improved early and late survival, as well as enhanced quality of life of patients with pediatric and/or congenital heart disease treated with surgery and interventional cardiac catheterization across Europe and the world.

Our goal was to evaluate the early and late results of the surgical management of congenital supravalvular aortic stenosis (SVAS). We performed a retrospective, multicentre study using data from the European Congenital Heart Surgeons Association. Exclusion criteria were age >18 years, operation before 1990 and redo supravalvular aortic stenosis operations. Multivariate Cox regression analysis was performed to detect independent predictors of adverse events. Of a total of 301 patients (male/female = 194/107; median age 3.9 years, range 13 days-17.9 years), 17.6% had a prior surgical or interventional procedure. Pulmonary artery stenosis was present in 41.5% and coronary anomalies in 13.6%. The operation consisted of a single patch repair in 36.7%, a pantaloon-shaped patch in 36.7%, a 3-patch technique in 14.3% and other techniques in 11.7%. Postoperative complications occurred in 14.9%, and the early mortality rate was 5%. At a median follow-up of 13 years (interquartile range 3.5-7.8; follow-up completed 79.1%), there were 10 late deaths (4.2%). A surgical reoperation or an interventional cardiology procedure occurred in 12.6% and 7.2%, respectively. No significant differences in outcomes between the techniques were found. Age at repair <12 months and pulmonary artery stenosis were associated with an increased risk of early (P = 0.0001) and overall mortality (P = 0.025), respectively. Having an operation after 2005 and co-existing pulmonary artery stenosis were significant predictors of late reintervention (P = 0.0110 and P = 0.001, respectively). Surgical repair of congenital stenosis is an effective procedure with acceptable surgical risk and good late survival, but late morbidity is not negligible, especially in infants and when associated pulmonary artery stenosis is present.

Insights from the thoracic surgery residents association early-career development series

The Congenital Cardiac Anesthesia Society was formed in 2005 by representatives from many of the busiest congenital cardiac surgical programs in North America and is now in the process of partnering with The Society of Thoracic Surgeons to create a joint congenital cardiac surgery and congenital cardiac anaesthesia database. Even the busiest of congenital cardiac programs have a low frequency of anaesthesia-related cardiac complications and deaths. One of the only mechanisms for accurately determining the incidence and outcomes of low frequency events is to aggregate large amounts of data from multiple sources. To that end, the Congenital Cardiac Anesthesia Society has joined with the Society of Thoracic Surgeons Congenital Database Task Force to incorporate anaesthesia-specific data points into their surgical registry, which is now the largest single reporting site for children and adults undergoing surgical repair of congenital cardiac malformations in North America. The Joint Congenital Cardiac Anesthesia Society--Society of Thoracic Surgeons Database will therefore become an optional module of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Initial data fields have been selected and are presented in this article. Efforts are ongoing to make this initiative a global project. Initial collaborative discussions have taken place about the possibility of linking this initiative with the European Association of Cardiothoracic Anesthesiologists. It is certainly possible and desirable that the planned anaesthesia module of The Society of Thoracic Surgeons Congenital Heart Database has an identical module in the congenital heart database of The European Association for Cardio-Thoracic Surgery and The European Congenital Heart Surgeons Association. This project should also ideally spread beyond North America and Europe. Efforts to involve Africa, Asia, Australia, and South America are necessary and already underway. The creation of a joint cardiac surgery and anaesthesia database is another step towards the ultimate goal of creating a database for congenital heart disease that spans both geographical and subspecialty boundaries.

Methylprednisolone for Cardiac Surgery in Infants: Findings From a Large-scale, Randomized, Controlled Trial

Despite significant advances in numerous fields of biofabrication, clinical application of biomaterials combined with bioactive molecules and/or cells largely remains a promise in an individualized patient settings. Three-dimensional (3D) printing and bioprinting evolved as promising techniques used for tissue-engineering, so that several kinds of tissue can now be printed in layers or as defined structures for replacement and/or reconstruction in regenerative medicine and surgery. Besides technological, practical, ethical and legal challenges to solve, there is also a gap between the research labs and the patients’ bedside. Congenital and pediatric cardiac surgery mostly deal with reconstructive patient-scenarios when defects are closed, various segments of the heart are connected, valves are implanted. Currently available biomaterials lack the potential of growth and conduits, valves derange over time surrendering patients to reoperations. Availability of viable, growing biomaterials could cancel reoperations that could entail significant public health benefit and improved quality-of-life. Congenital cardiac surgery is uniquely suited for closing the gap in translational research, rapid application of new techniques, and collaboration between interdisciplinary teams. This article provides a succinct review of the state-of-the art clinical practice and biofabrication strategies used in congenital and pediatric cardiac surgery, and highlights the need and avenues for translational research and collaboration.

STS Adult Cardiac Surgery Database: 2021 Update on Outcomes, Quality, and Research

Context: In this review, we tried to evaluate the incidence, prognosis and treatment options in patients with iatrogenic pathology of the aortic artery due to interventional procedures in cardiology. Evidence Acquisition: Our search strategy involved an investigation in the PUBMED database for every available article in peer reviewed journals between 1975 and 2015, for subjects related to iatrogenic pathology of the aortic artery, following interventional procedures in cardiology (coronary angiography or angioplasty, trans-catheter aortic valve implantation (TAVI) or intra-aortic balloon pump (IABP) counterpulsation placement). Results: Iatrogenic pathology of the aorta is a rare, but potentially lethal complication of invasive vascular techniques. The development of these complications should be considered in cases of unexplained hypotension, acidosis or lower limb ischemia after catheter-based interventions. With increased experience, most of the vascular complications associated with the transfemoral approach may be managed percutaneously. Conclusions: With the increase in interventional procedures in cardiology, iatrogenic pathology of the aorta is seen more frequently, and every cardiologist should know how to diagnose and treat this group of diseases.

Context: In this review, we tried to evaluate the incidence, prognosis and treatment options in patients with iatrogenic pathology of the aortic artery due to interventional procedures in cardiology. Evidence Acquisition: Our search strategy involved an investigation in the PUBMED database for every available article in peer reviewed journals between 1975 and 2015, for subjects related to iatrogenic pathology of the aortic artery, following interventional procedures in cardiology (coronary angiography or angioplasty, trans-catheter aortic valve implantation (TAVI) or intra-aortic balloon pump (IABP) counterpulsation placement). Results: Iatrogenic pathology of the aorta is a rare, but potentially lethal complication of invasive vascular techniques. The development of these complications should be considered in cases of unexplained hypotension, acidosis or lower limb ischemia after catheter-based interventions. With increased experience, most of the vascular complications associated with the transfemoral approach may be managed percutaneously. Conclusions: With the increase in interventional procedures in cardiology, iatrogenic pathology of the aorta is seen more frequently, and every cardiologist should know how to diagnose and treat this group of diseases.

Mapping interventional cardiology in Europe: the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Atlas Project.

Patient’s Peak Skin Dose evaluation using Gafchromic films in interventional cardiology procedures and its correlation with other dose indicators

Objective: To describe the patterns of care and costs associated with vascular closure device (VCD) use in interventional cardiology and peripheral vascular interventions in hospital outpatient departments from a Medicare perspective. Methods: Medicare outpatient use of vascular closure devices was identified using Health Care Procedure Coding System (HCPCS) code C1760 billed by hospitals during 2010 and found in Medicare’s Outpatient Prospective Payment System (OPPS) Limited Data Set (LDS). Hospital volumes, charges, costs, and reimbursements were summarized by hospital and by Hospital Referral Region (HRR) as defined by the Dartmouth Atlas of Health Care. Hospital contribution margins (profitability) for procedures using vascular closure devices were calculated as well. Results: We found a total of 272,589 vascular closure devices billed for both interventional cardiology procedures (75%, 205,612 of 272,589) and peripheral vascular interventions (25%, 66,977 of 272,589). The rate of vascular closure device usage was higher among diagnostic and therapeutic interventional cardiology procedures than peripheral vascular procedures (34%, 205,612 of 604,322 versus 24%, 66,977 of 277,342). Total vascular closure device costs billed to Medicare in outpatient hospital settings were $82.1 million. Average device cost per procedure was around $300. The top 5 hospitals for VCD use were different for interventional cardiology versus peripheral interventions. Additionally, the top 5 hospitals that used VCDs for interventional cardiology procedures were primarily due to diagnostic catheterizations and not interventions. Conclusions: Frequent users (hospitals) of VCDs seem to be associated with diagnostic use as opposed to interventional use. VCDs are more widely used with cardiovascular procedures versus peripheral procedures. There is significant variation in VCD use across the country, seemingly unrelated to total interventional procedure volume.

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Assessment of Risk Factors for a Sustainable “On-Table Extubation” Program in Pediatric Congenital Cardiac Surgery: 5-Year Experience