Ali N. Zaidi

3D Printing to Guide Ventricular Assist Device Placement in Adults With Congenital Heart Disease and Heart Failure

As the population of adults with congenital heart disease continues to grow, so does the number of these patients with heart failure. Ventricular assist devices are underutilized in adults with congenital heart disease due to their complex anatomic arrangements and physiology. Advanced imaging techniques that may increase the utilization of mechanical circulatory support in this population must be explored. Three-dimensional printing offers individualized structural models that would enable pre-surgical planning of cannula and device placement in adults with congenital cardiac disease and heart failure who are candidates for such therapies. We present a review of relevant cardiac anomalies, cases in which such models could be utilized, and some background on the cost and procedure associated with this process.

Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis ☆ ☆☆

BACKGROUNDnSecundum atrial septal defects (ASDs) are treated by surgical closure (SC) or transcatheter device closure (TCC). Due to a scarcity of data directly comparing these approaches, it remains unclear which is superior. This meta-analysis compares the clinical outcomes of the two treatment options.nnnMETHODSnA literature search was performed in MEDLINE, Embase, PubMed, Google Search, and Cochrane databases for studies directly comparing SC and TCC of ASDs. Outcomes studied were major and minor acute complications, all-cause mortality, residual shunt, reinterventions, and length of stay (LOS). Relative risk (RR), difference in mean (DM) and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method with a fixed effect model. In cases of heterogeneity (defined as I2>25%), random effect models were used. Sensitivity and meta-regression analyses were performed for each outcome.nnnRESULTSnOf the 1742 manuscripts screened, 26 observational studies fulfilled the inclusion criteria (total n=14,559 patients). TCC was superior to SC for the following outcomes: all-cause mortality (RR, 0.66; 95% CI 0.64-0.99), total complications (RR, 0.48; 95% CI 0.35-0.65), major complications (RR, 0.57; 95% CI 0.40-0.81), minor complications (RR, 0.35; 95% CI 0.23-0.53), and LOS (DM, -2.92; 95% CI -3.25 to (-2.58)). Residual shunts were more common with TCC (RR, 3.35; 95% CI 1.72-6.51). No difference was observed regarding the need of reintervention (RR, 1.45; 95% CI 0.60-3.51). Meta-regression analysis showed that older age increases the risk of death and complications in patients undergoing TCC.nnnCONCLUSIONSnThough both approaches are effective, TCC is associated with lower mortality, complications, and LOS while SC has a lower rate of residual shunting.

Health Care Costs for Adults With Congenital Heart Disease in the United States 2002 to 2012

More adults than children with congenital heart disease (CHD) are alive today. Few studies have evaluated adult congenital heart disease (ACHD) health care utilization in the United States. Data from the National Inpatient Sample from 2002 to 2012, using International Classification of Diseases, Ninth Revision, codes for moderate and complex CHD were analyzed. Hospital discharges, total billed and reimbursed amounts, length of stay, and gender/age disparities were evaluated. There was an increase in CHD discharges (moderate CHD: 4,742 vs 6,545; severe CHD: 807 vs 1,115) and total billed and reimbursed dollar amounts across all CHD (billed:

Location matters: left heart obstruction in pregnancy.

2.7 vs

Long Term Consequences of the Fontan Procedure and How to Manage Them

7.0 billion, 155% increase; reimbursed:

Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties.

1.3 vs

Cardiothoracic CT and MRI in adults with tetralogy of Fallot: 11-year experience in a diverse, inner-city population

2.3 billion, 99% increase) and in the ACHD subgroup (billed:

Evaluation of Left Ventricular Systolic Function after Pulmonary Valve Replacement Using Cardiovascular Magnetic Resonance Imaging

543 million vs

A PREGNANCY SURVEY: CURRENT ATTITUDE OF WOMEN WITH CONGENITAL HEART DISEASE REGARDING PREGNANCY IN NORTH AMERICA

1.5 billion, 178% increase; reimbursed:

TCT-740 Treatment Options for the Closure of Secundum Atrial Septal Defect: A Systematic Review and Meta-Analysis

221 vs