Presentation is loading. Please wait.

Presentation is loading. Please wait.

Determinants of repair type, reintervention, and mortality in 393 children with double- outlet right ventricle  Timothy J. Bradley, MD, Tara Karamlou,

Published byInge Sumadi Modified over 5 years ago

Similar presentations

Presentation on theme: "Determinants of repair type, reintervention, and mortality in 393 children with double- outlet right ventricle  Timothy J. Bradley, MD, Tara Karamlou,"— Presentation transcript:

1 Determinants of repair type, reintervention, and mortality in 393 children with double- outlet right ventricle  Timothy J. Bradley, MD, Tara Karamlou, MD, Alex Kulik, MD, Bojana Mitrovic, MD, Trisha Vigneswaran, MD, Salima Jaffer, MD, Patrick D. Glasgow, MS, William G. Williams, MD, Glen S. Van Arsdell, MD, Brian W. McCrindle, MD, MPH  The Journal of Thoracic and Cardiovascular Surgery  Volume 134, Issue 4, Pages e6 (October 2007) DOI: /j.jtcvs Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Non–risk adjusted competing risks estimates for the proportion of 393 children with DORV reaching each of 4 end-states after birth. All patients begin alive and thereafter migrate to 1 of 4 mutually exclusive end-states (achievement of biventricular repair, achievement of single-ventricle repair, death before reaching definitive repair, and remaining alive without repair) at a time-dependent rate defined by the underlying hazard functions. At any point in time, the sum of the proportion of children in each state is 100%. For example, the estimated prevalences after 5 years from birth are as follows: biventricular repair, 53%; single-ventricle repair, 14%; death without repair, 15%; remaining alive without repair, 18%. Parametric point estimates (solid lines); 70% confidence interval (dashed lines); estimated proportion of patients in each state at 5 years from birth (numbers in parentheses).1-v, Single ventricle; 2-v, biventricular. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Risk-adjusted multivariable competing risks depiction of pre-repair end-states stratified by recent birth decade (year 2000) (B) compared with older birth decade (year 1980) (A) for an ideal patient aged 1 year with favorable anatomy. Mortality is increased, with a significant proportion of patients waiting for definitive repair in an earlier era (A), compared with a dramatic reduction in pre-repair attrition (1%) concomitant with a significant increase in the proportion of children achieving definitive repair. Continuous point estimates (solid lines) and the predicted proportion of patients achieving each end-state at 5 years from birth (numbers underneath each caption). 1-v, Single ventricle; 2-v, biventricular. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Non–risk adjusted competing risks estimates for the proportion of 276 children with DORV reaching each of 3 end-states after complete repair. All patients begin alive at the time of repair (time 0) and thereafter migrate to 1 of 3 mutually exclusive end-states (subsequent reintervention, death without reintervention, and remaining alive without subsequent reintervention) at a time-dependent rate defined by the underlying hazard functions. At any point in time, the sum of the proportion of children in each state is 100%. For example, the estimated prevalences after 15 years from repair are as follows: reintervention, 37%; death, 26%; and remaining alive without reintervention, 37%. Parametric point estimates (solid lines); 70% confidence interval (dashed lines); estimated proportion of patients in each state at 15 years from repair (numbers in parentheses). The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 A, Risk-adjusted survival without reoperation in a patient weighing 4 kg, stratified by repair type, either baffle closure of the VSD to the aorta (n = 133) or arterial switch operation with baffle closure of the VSD to the neoaorta (n = 23). The arterial switch operation has a higher early attrition after repair but results in improved long-term survival free of operation at 15 years. Parametric point-estimates (solid lines) enclosed by 70% confidence limits (dashed lines). B, Risk-adjusted hazard functions (solid lines) from our multivariable competing risk models stratified by 2 different repair types. The hazard function represents the instantaneous risk of death before reoperation at each moment in time after repair and consisted of a constant phase that predominated until 3 years after repair, followed by an accelerated late-phase mortality risk. VSD, ventricular septal defect. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

6 Figure E1 Flow-chart of events after birth in 393 children with anatomically proven DORV. Overall, there were 194 deaths during the duration of the study. There were 41 patients who had no interventional procedure and 76 patients who had only palliative procedures. DORV, Double-outlet right ventricle; 1V, single ventricle; 2V, biventricular. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

7 Figure E2 Overall survival from birth was 75% at 1 year, 65% at 5 years, and 56% at 15 years (70% confidence intervals: 53%-59%). There was a rapidly declining early risk of death (inset) followed by a tapering late risk thereafter. Parametric estimates (solid lines) surrounded by their 70% confidence limits (dashed lines). Nonparametric estimates (circles) with error bars equivalent to 1 standard error. Insert, parametric hazard function (solid curve) with 70% confidence limits (dashed curve) represents the instantaneous risk of death at any given time up to 15 years after birth. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

8 Figure E3 Death after complete repair (n = 64) but without reoperation was 96%, 86%, and 63% at 5, 10, and 15 years after repair, respectively. Mortality risk was characterized by a constant hazard phase that predominated for 3 years after repair followed by a rapidly increasing late hazard phase (inset) that escalated 3 years after repair. Parametric estimates (solid lines) surrounded by 70% confidence limits (dashed lines). Nonparametric estimates (circles with error bars) and number of patients traced at that time point (numbers at the bottom horizontal axis). The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Download ppt "Determinants of repair type, reintervention, and mortality in 393 children with double- outlet right ventricle  Timothy J. Bradley, MD, Tara Karamlou,"

Similar presentations

Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine 

Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine 
Robert J. Dabal, MD, James K

Robert J. Dabal, MD, James K
Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status.

Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status.
Prediction of recurrent coarctation by early postoperative blood pressure gradient  T. K. Susheel Kumar, MD, David Zurakowski, PhD, Rishika Sharma, MD,

Prediction of recurrent coarctation by early postoperative blood pressure gradient  T. K. Susheel Kumar, MD, David Zurakowski, PhD, Rishika Sharma, MD,
Advising complex patients who require complex heart operations

Advising complex patients who require complex heart operations
Should lung transplantation be performed for patients on mechanical respiratory support? The US experience  David P. Mason, MD, Lucy Thuita, MS, Edward.

Should lung transplantation be performed for patients on mechanical respiratory support? The US experience  David P. Mason, MD, Lucy Thuita, MS, Edward.
Lars G. Svensson, MD, PhD, Lillian H. Batizy, MS, Eugene H

Lars G. Svensson, MD, PhD, Lillian H. Batizy, MS, Eugene H
Can pulmonary conduit dysfunction and failure be reduced in infants and children less than age 2 years at initial implantation?  Tara Karamlou, MD, Eugene.

Can pulmonary conduit dysfunction and failure be reduced in infants and children less than age 2 years at initial implantation?  Tara Karamlou, MD, Eugene.
Effect of changes in postoperative spirometry on survival after lung transplantation  David P. Mason, MD, Jeevanantham Rajeswaran, MSc, Liang Li, PhD,

Effect of changes in postoperative spirometry on survival after lung transplantation  David P. Mason, MD, Jeevanantham Rajeswaran, MSc, Liang Li, PhD,
Outcomes After Late Reoperation in Patients With Repaired Tetralogy of Fallot: The Impact of Arrhythmia and Arrhythmia Surgery  Tara Karamlou, MD, Ilana.

Outcomes After Late Reoperation in Patients With Repaired Tetralogy of Fallot: The Impact of Arrhythmia and Arrhythmia Surgery  Tara Karamlou, MD, Ilana.
Endovascular versus open elephant trunk completion for extensive aortic disease  Eric E. Roselli, MD, Sreekumar Subramanian, MD, Zhiyuan Sun, BS, Jahanzaib.

Endovascular versus open elephant trunk completion for extensive aortic disease  Eric E. Roselli, MD, Sreekumar Subramanian, MD, Zhiyuan Sun, BS, Jahanzaib.
Surgical treatment of pseudoaneurysm of the thoracic aorta

Surgical treatment of pseudoaneurysm of the thoracic aorta
Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries  Gil Wernovsky, MD* (by invitation),

Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries  Gil Wernovsky, MD* (by invitation),
Bahaaldin Alsoufi, MD, Cedric Manlhiot, BSc, William T

Bahaaldin Alsoufi, MD, Cedric Manlhiot, BSc, William T
Mauro Lo Rito, MD, Tamadhir Gazzaz, MD, Travis J. Wilder, MD, Rachel D

Mauro Lo Rito, MD, Tamadhir Gazzaz, MD, Travis J. Wilder, MD, Rachel D
The Optimal Timing of Stage-2-Palliation After the Norwood Operation

The Optimal Timing of Stage-2-Palliation After the Norwood Operation
Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome  Soren Schenk, MD, Patrick M. McCarthy,

Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome  Soren Schenk, MD, Patrick M. McCarthy,
Surgical repair of multiple muscular ventricular septal defects: The role of re- endocardialization strategy  Bahaaldin Alsoufi, MD, Tara Karamlou, MD,

Surgical repair of multiple muscular ventricular septal defects: The role of re- endocardialization strategy  Bahaaldin Alsoufi, MD, Tara Karamlou, MD,
Coronary artery bypass grafting in diabetics: A growing health care cost crisis  Sajjad Raza, MD, Joseph F. Sabik, MD, Ponnuthurai Ainkaran, MS, Eugene.

Coronary artery bypass grafting in diabetics: A growing health care cost crisis  Sajjad Raza, MD, Joseph F. Sabik, MD, Ponnuthurai Ainkaran, MS, Eugene.
Lesion-specific outcomes in neonates undergoing congenital heart surgery are related predominantly to patient and management factors rather than institution.

Lesion-specific outcomes in neonates undergoing congenital heart surgery are related predominantly to patient and management factors rather than institution.

Similar presentations

Ads by Google