Dhaval Chauhan

Objectives: Patients with a single ventricle and systemic outflow obstruction undergo 1 of 3 stage 1 palliative operations: Norwood-Sano, Norwood-Modified Blalock-Taussig-Thomas shunt (mBTTs), or stage 1 hybrid palliation. We evaluated real-world outcomes for patients undergoing stage 1 palliation strategies in a national dataset. Methods: The Kids’ Inpatient Database (KID) was queried for patients undergoing Norwood and hybrid procedures for the years 2016, 2019, and 2019. Data were extracted using International Classification of Diseases (ICD-10) codes. Using survey weights, an estimated national cohort was derived. Multilevel, multivariable logistic regression models evaluated risk-adjusted mortality and post-operative extracorporeal membrane oxygenation (ECMO). Operations were plotted by hospital mortality for the entire sample. Results: A total of 1918 patients underwent stage 1 palliation with Norwood-Sano (1046, 54.5%), Norwood-mBTT shunt (770, 40.1%), or hybrid procedure (102, 5.3%). Unadjusted inpatient mortality was 9.0% for Norwood-Sano, 11.5% for Norwood-mBTT shunt, and 18.7% for the hybrid procedure. After risk adjustment, there was no significant difference in risk-adjusted inpatient mortality for Norwood-mBTTs (OR 1.25, P = .248) or hybrid procedures (OR 2.01, P = .057) compared to Norwood-Sano. There was no difference in need for ECMO for Norwood-mBTT shunt (OR 0.90, P = .78), or hybrid procedure (OR 0.50, P = .37). Finally, compared to Norwood-Sano, the use of mBTTs or hybrid procedures was higher in high-mortality hospitals. Conclusions: Compared to historical data, outcomes for stage 1 palliative procedures are improving over historical norms. There was no difference in risk-adjusted inpatient mortality or ECMO comparing Norwood-Sano to Norwood-mBTTs. These data may aid the evolution of operative strategies.

To evaluate the relationship between center volume and inpatient mortality among patients transferred to another hospital for pediatric cardiac surgery using contemporary real-world data. The Kids' Inpatient Database (KID) was queried for cardiopulmonary bypass (CPB) cases for the years 2016 and 2019. Hospitals were divided into three groups based on terciles of volume: low: ≤ 103 cases/year, mid: 104-194 cases/year, and high: > 194 cases/year. Multilevel regression models were created to evaluate the association between volume and inpatient mortality for transferred patients, both for the entire cohort and for high-complexity cases. (Risk Stratification for Congenital Heart Surgery (RACHS-2) categories 3,4, and 5). Of 25,749 patients undergoing cases on CPB, 3511 (13.6%) were preoperative inpatient transfers between hospitals. Compared to direct admissions, unadjusted mortality for patients who were transferred was higher in all groups: 1.7% vs 5.6% (low-volume), 1.1% vs 4.6% (mid-volume) and 1.1% vs 4.9% (high-volume). Compared to low-volume hospitals, inpatient mortality for patients admitted on transfer was not significantly different in mid-volume (OR = 0.85, 95% CI 0.54-1.34, p = 0.483) and high-volume centers (OR = 0.7, 95% CI 0.45-1.12, p = 0.127) for the entire cohort. There was no significant difference in risk-adjusted inpatient mortality for high-complexity cases performed at mid-volume (OR 1.06, p = 0.845, 95% CI (0.62-1.85)) or high-volume hospitals (OR 0.82, p = 0.482, 95% CI (0.48-1.45)) compared to low-volume hospitals. Annual CPB case volume may not accurately predict risk-adjusted inpatient mortality for children transferred for pediatric cardiac surgery. Annual case volume alone should not dictate transfer for surgical care.

KCNT1 mutations are associated with childhood epilepsy, developmental delay, and vascular malformations. We report a child with a likely pathogenic KCNT1 mutation (c.1885A>C, p.Lys629Glu) with recurrent pulmonary haemorrhage due to aortopulmonary collaterals successfully managed with coil embolisation followed by right upper lobectomy.

Ganglioneuroma is a benign tumor requiring subtotal resection as a primary mode of treatment. There are several surgical approaches. A giant ganglioneuroma of the chest cavity may be approached via a clamshell thoracotomy. This manuscript presents a case of giant ganglioneuroma resected en bloc via clamshell thoracotomy in a seven-year-old child.

Effect of Process Parameters on Tensile Strength of Polyethylene Terephthalate Glycol Material Specimens 3D Printed Using Material Extrusion Dhaval Chauhan1, […]

Background: The impact of frailty status on TAVR outcomes in nonagenarians is unknown. The present study aims to investigate the impact of frailty status on procedural outcomes and overall survival in nonagenarians after TAVR.Methods: A frailty score (FS) was derived by using preoperative grip strength, gait speed, serum albumin, and daily activities. Patients were divided into two groups: Frail (FS ≥ 3/4) and Non‐Frail (FS 90 years underwent full assessment for frailty status. There was a significant improvement in overall health status of non‐frail patients (mean difference: 11.03, P = 0.032). Unadjusted 30‐day and 2‐year mortality rates were higher in the frail group than the non‐frail group. (14% vs. 2% P = 0.059; 31% vs. 9% P = 0.018). Kaplan‐Meier estimated all‐cause mortality to be significantly higher in the frail group (log‐rank test; P = 0.042). Frailty status was independently associated with increased mortality (hazard ratio: 1.84, 95% C.I: 1.06–3.17; P = 0.028) after TAVR.Conclusion: Among nonagenarians selected to undergo TAVR for severe aortic stenosis, a considerable number are frail. Nonfrail patients report a significant improvement in overall health status in the short term. Worse frailty is strongly associated with diminished long‐term survival.