FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2604323277> ?p ?o ?g. }

• W2604323277 endingPage "571" @default.
• W2604323277 startingPage "570" @default.
• W2604323277 abstract "Central MessageNew pathophysiologic knowledge on SLVR and BiV repair in a borderline left heart is gained from this study, but observed survival makes the strategy less certain.See Article page 572. New pathophysiologic knowledge on SLVR and BiV repair in a borderline left heart is gained from this study, but observed survival makes the strategy less certain. See Article page 572. The question “Is a patient better off with single ventricle palliation (SVP) versus a complex biventricular (BiV) repair?” is frequently asked during many catheter conferences across the world. It is a vexing question, for there is no good solid scientific evidence on which to base any answer. No group is better positioned to shed light on the issue than the Boston group.1Herrin M.A. Zurakowski D. Baird C.W. Banka P. Esch J.J. del Nido P.J. Emani S.M. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single ventricle palliation takedown.J Thorac Cardiovasc Surg. 2017; 154: 572-582Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar This article focuses on patients who have been initially managed with SVP and are, after staged left ventricular recruitment (SLVR) procedures (a combination of atrial septal defect restriction, aortic or mitral valve replacement or repair, and endocardial fibroelastosis resection), considered for takedown and BiV repair. This study is commendable for 2 reasons: (1) It focuses strictly on the 2 main diagnostic groups only (without contamination by other groups), and (2) it attempts to add a physiologic variable to our decision-making armamentarium. Thus far, imaging data from echocardiography (size and function) and magnetic resonance (size, function, and flow) primarily have been used.2Emani S.M. McElhinney D.B. Tworetzky W. Myers P.O. Schroeder B. Zurakowski D. et al.Staged left ventricular recruitment after single-ventricle palliation in patients with borderline left heart hypoplasia.J Am Coll Cardiol. 2012; 60: 1966-1974Crossref PubMed Scopus (115) Google Scholar, 3Mery C.M. Nieto R.M. De León L.E. Morris S.A. Zhang W. Colquitt J.L. et al.The role of echocardiography and intracardiac exploration in the evaluation of candidacy for biventricular repair in patients with borderline left heart structures.Ann Thorac Surg. 2017; 103: 853-861Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 4Cavigelli-Brunner A. Bauersfeld U. Prêtare R. Kretschmar O. Oxenius A. Valsangiacomo Buechel E.R. Outcome of biventricular repair in infants with multiple left heart obstructive lesions.Pediatr Cardiol. 2012; 33: 506-512Crossref PubMed Scopus (14) Google Scholar We learn several things:1.The predictive preoperative physiologic marker was a left ventricular end-diastolic pressure (LVEDP) of 13 mm Hg or more. Of note, the preoperative left atrial pressure was not, presumably because of the often present mitral valve anomalies.2.The primary end point (consisting of death, heart transplant, or BiV takedown) was reached by 22% (11/51) of patients. Ten of the 11 patients had hypoplastic left heart syndrome (HLHS). Despite falling out of the multivariable analysis in the end, this is powerful evidence, statistics or not, that borderline HLHS is a risk factor for poor outcomes. Also, one third of patients with borderline HLHS experienced a primary end point versus only 1 of 18 patients with unbalanced atrioventricular canal.3.Patients with SLVR and BiV repair in whom elevated right ventricular pressure greater than three quarters of the systolic blood pressure develops will essentially reach one of the primary end points.4.Surgical reintervention after BiV conversion was required in approximately half (49%) of the patients.5.Finally, and most important, the survival statistics exposed in this study are sobering: a transplant-free survival of 80% at 3 years for the entire cohort (85% for the group with LVEDP <13 and 60% for the other group). This is in a setting where patients were preselected for BiV conversion only if they demonstrated growth of left heart structures! In addition, because the survival curve starts at the time of BiV surgery, these patients already have incurred a risk during their previous surgeries, and their survival starts to look similar to that of 1-year survivors of HLHS palliation: 90% to 95% survival at 3 years.5Newburger J.W. Sleeper L.A. Frommelt P.C. Pearson G.D. Mahle W.T. Chen S. et al.Transplantation-free survival and interventions at 3 years in the single ventricle reconstruction trial.Circulation. 2014; 129: 2013-2020Crossref PubMed Scopus (146) Google Scholar Granted, the principal aim of the study was to “investigate pre- and postoperative hemodynamics and outcomes in BiV following SVP.”1Herrin M.A. Zurakowski D. Baird C.W. Banka P. Esch J.J. del Nido P.J. Emani S.M. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single ventricle palliation takedown.J Thorac Cardiovasc Surg. 2017; 154: 572-582Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar This aim has been achieved. However, the authors also aim to “describe a single institution experience with BiV conversion,”1Herrin M.A. Zurakowski D. Baird C.W. Banka P. Esch J.J. del Nido P.J. Emani S.M. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single ventricle palliation takedown.J Thorac Cardiovasc Surg. 2017; 154: 572-582Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar and that side of the story, I would argue, has not been sufficiently debated. The patients who are candidates for SLVR and BiV repair typically can be divided into 2 groups: one group that is not tolerating SVP (eg, patients with protein-losing enteropathy) and one group that is doing well clinically but has left-sided heart structures that are deemed possible to rehabilitate. Given the survival data and the high number of total surgeries per patient required, it would be crucial to understand what the preoperative status was. If these were mostly elective surgeries and decision-making was made on the basis of favorable structural left heart components in an otherwise well patient with single-ventricle (SV) physiology, one should pause and contemplate whether this is the correct approach. In the article, the authors mention only that “the majority of patients had risk-factors for SV palliation,”1Herrin M.A. Zurakowski D. Baird C.W. Banka P. Esch J.J. del Nido P.J. Emani S.M. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single ventricle palliation takedown.J Thorac Cardiovasc Surg. 2017; 154: 572-582Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar without giving any more details. Indeed, if one is to try to make a grand philosophical judgment on the merits of the SLVR/BiV approach, what is missing is data on the clinical indications for going down this route as opposed to staying on SV palliation. Many of the findings of this article are meaningful in a practical way.1Herrin M.A. Zurakowski D. Baird C.W. Banka P. Esch J.J. del Nido P.J. Emani S.M. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single ventricle palliation takedown.J Thorac Cardiovasc Surg. 2017; 154: 572-582Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar The next time I see a patient with borderline HLHS and elevated LVEDP, I might be more circumspect in recommending BiV conversion. Conversely, I might be more aggressive with a patient with unbalanced atrioventricular canal. The increase in right ventricular pressure also is concerning. The authors are recommending regular (ie, annual) [sic] catheterizations, a not insignificant burden and a sign that the specter of pulmonary hypertension can never be ignored in these patients.1Herrin M.A. Zurakowski D. Baird C.W. Banka P. Esch J.J. del Nido P.J. Emani S.M. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single ventricle palliation takedown.J Thorac Cardiovasc Surg. 2017; 154: 572-582Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar At this junction, for the patients with borderline HLHS and elevated LVEDP not tolerating SV physiology, we might have to change our thinking, such as recommending heart transplantation or assist devices. There is no doubt that the cumulative team experience in Boston has helped many patients reach meaningful survival with BiV physiology. We are hopeful that these new data will allow, at least for practitioners who like me are believers in this approach, for better triage of the patients who will be the real beneficiaries. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single-ventricle palliation takedownThe Journal of Thoracic and Cardiovascular SurgeryVol. 154Issue 2PreviewPatients with a borderline left ventricular hypoplasia in the hypoplastic left heart syndrome variant or an unbalanced atrioventricular canal who undergo initial single-ventricle palliation may be candidates for biventricular (BiV) conversion following left ventricle (LV) recruitment procedures. We investigated associations among preoperative parameters and postoperative outcomes in patients undergoing BiV conversion. Full-Text PDF Open Archive" @default.
• W2604323277 created "2017-04-14" @default.
• W2604323277 creator A5039065099 @default.
• W2604323277 date "2017-08-01" @default.
• W2604323277 modified "2023-09-30" @default.
• W2604323277 title "Borderline left ventricle: Trying to see the forest for the trees" @default.
• W2604323277 cites W2049438359 @default.
• W2604323277 cites W2065823779 @default.
• W2604323277 cites W2087826251 @default.
• W2604323277 cites W2529509155 @default.
• W2604323277 cites W2607445367 @default.
• W2604323277 doi "https://doi.org/10.1016/j.jtcvs.2017.03.093" @default.
• W2604323277 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/28434618" @default.
• W2604323277 hasPublicationYear "2017" @default.
• W2604323277 type Work @default.
• W2604323277 sameAs 2604323277 @default.
• W2604323277 citedByCount "6" @default.
• W2604323277 countsByYear W26043232772018 @default.
• W2604323277 countsByYear W26043232772021 @default.
• W2604323277 countsByYear W26043232772022 @default.
• W2604323277 countsByYear W26043232772023 @default.
• W2604323277 crossrefType "journal-article" @default.
• W2604323277 hasAuthorship W2604323277A5039065099 @default.
• W2604323277 hasBestOaLocation W26043232771 @default.
• W2604323277 hasConcept C126322002 @default.
• W2604323277 hasConcept C164705383 @default.
• W2604323277 hasConcept C2778921608 @default.
• W2604323277 hasConcept C71924100 @default.
• W2604323277 hasConceptScore W2604323277C126322002 @default.
• W2604323277 hasConceptScore W2604323277C164705383 @default.
• W2604323277 hasConceptScore W2604323277C2778921608 @default.
• W2604323277 hasConceptScore W2604323277C71924100 @default.
• W2604323277 hasIssue "2" @default.
• W2604323277 hasLocation W26043232771 @default.
• W2604323277 hasLocation W26043232772 @default.
• W2604323277 hasOpenAccess W2604323277 @default.
• W2604323277 hasPrimaryLocation W26043232771 @default.
• W2604323277 hasRelatedWork W1997415951 @default.
• W2604323277 hasRelatedWork W2011347913 @default.
• W2604323277 hasRelatedWork W2049397185 @default.
• W2604323277 hasRelatedWork W2074833529 @default.
• W2604323277 hasRelatedWork W2092630756 @default.
• W2604323277 hasRelatedWork W2159512267 @default.
• W2604323277 hasRelatedWork W2304633692 @default.
• W2604323277 hasRelatedWork W2391627734 @default.
• W2604323277 hasRelatedWork W2399063111 @default.
• W2604323277 hasRelatedWork W4247616541 @default.
• W2604323277 hasVolume "154" @default.
• W2604323277 isParatext "false" @default.
• W2604323277 isRetracted "false" @default.
• W2604323277 magId "2604323277" @default.
• W2604323277 workType "article" @default.