Kimberly Y. Lin

Mechanical embolectomy for ischemic stroke in a pediatric ventricular assist device patient

The reported incidence of cerebral embolic or hemorrhagic complications related to mechanical circulatory support in children is high, even while subjects are managed with aggressive antithrombotic therapy. The safety and utility of endovascular treatment for stroke in the pediatric VAD population has not been established in the published literature. We describe a nine‐yr‐old patient on BiVAD support who experienced threatened AIS on two separate occasions. He was treated successfully via mechanical embolectomy on both occasions and survived to transplantation with minimal neurologic deficits.

Cross-Sectional Analysis of Electrocardiograms in a Large Heterogeneous Cohort of Friedreich Ataxia Subjects

Electrocardiographic (ECG) findings in Friedreich ataxia and their relation to disease characteristics have not been well described. In this retrospective cross-sectional study, the authors reviewed baseline ECGs from 239 children and adults with Friedreich ataxia. ECG abnormalities—assessed in relation to participant age, sex, shorter guanine-adenine-adenine triplet repeat length, age of disease onset, and functional disability score—were found in 90% of subjects, including nonspecific ST-T wave changes (53%), right axis deviation (32%), left ventricular hypertrophy (19%), and right ventricular hypertrophy (13%). Female sex and shorter guanine-adenine-adenine repeat lengths were associated with a normal ECG (P = .004 and P = .003). Males and those of younger age were more likely to show ventricular hypertrophy (P = .006 and P = .026 for left ventricular hypertrophy and P < .001 and P = .001 for right). Neurologic status as measured by the functional disability score did not predict ECG abnormalities.

The Use of Pediatric Ventricular Assist Devices in Children's Hospitals From 2000 to 2010: Morbidity, Mortality, and Hospital Charges.

Objective: The use of ventricular assist devices has increased dramatically in adult heart failure patients. However, the overall use, outcome, comorbidities, and resource utilization of ventricular assist devices in pediatric patients have not been well described. We sought to demonstrate that the use of ventricular assist devices in pediatric patients has increased over time and that mortality has decreased. Design: A retrospective study of the Pediatric Health Information System database was performed for patients 20 years old or younger undergoing ventricular assist device placement from 2000 to 2010. Interventions: None. Measurements and Main Results: Four hundred seventy-five pediatric patients were implanted with ventricular assist devices during the study period: 69 in 2000–2003 (era 1), 135 in 2004–2006 (era 2), and 271 in 2007–2010 (era 3). Median age at ventricular assist device implantation was 6.0 years (interquartile range, 0.5–13.8), and the proportion of children who were 1–12 years old increased from 29% in era 1 to 47% in era 3 (p = 0.002). The majority of patients had a diagnosis of cardiomyopathy; this increased from 52% in era 1 to 72% in era 3 (p = 0.003). Comorbidities included arrhythmias (48%), pulmonary hypertension (16%), acute renal failure (34%), cerebrovascular disease (28%), and sepsis/systemic inflammatory response syndrome (34%). Two hundred forty-seven patients (52%) underwent heart transplantation and 327 (69%) survived to hospital discharge. Hospital mortality decreased from 42% in era 1 to 25% in era 3 (p = 0.004). Median hospital length of stay increased (37 d [interquartile range, 12–64 d] in era 1 vs 69 d [interquartile range, 35–130] in era 3; p < 0.001) and median adjusted hospital charges increased (

Troponin I levels from donors accepted for pediatric heart transplantation do not predict recipient graft survival

630,630 [interquartile range,

Management and therapy for cardiomyopathy in Friedreich's ataxia.

227,052–

Pediatric Heart Transplantation From Donors With Depressed Ventricular FunctionClinical Perspective

853,318] in era 1 vs

Pediatric Heart Transplantation From Donors With Depressed Ventricular Function An Analysis of the United Network of Organ Sharing Database

1,577,983 [interquartile range,

Coronary Ostioplasty for Congenital Atresia of the Left Main Coronary Artery Ostium

874,463–

Changes in the methodology of pre‐heart transplant human leukocyte antibody assessment: an analysis of the United Network for Organ Sharing database

2,280,435] in era 3; p < 0.001). Factors associated with increased mortality include age less than 1 year (odds ratio, 2.04; 95% CI, 1.01–3.83), acute renal failure (odds ratio, 2.1; 95% CI, 1.26–3.65), cerebrovascular disease (odds ratio, 2.1; 95% CI, 1.25–3.62), and extracorporeal membrane oxygenation (odds ratio, 3.16; 95% CI, 1.79–5.60). Ventricular assist device placement in era 3 (odds ratio, 0.3; 95% CI, 0.15–0.57) and a diagnosis of cardiomyopathy (odds ratio, 0.5; 95% CI, 0.32–0.84), were associated with decreased mortality. Large-volume centers had lower mortality (odds ratio, 0.55; 95% CI, 0.34–0.88), lower use of extracorporeal membrane oxygenation, and higher charges. Conclusions: The use of ventricular assist devices and survival after ventricular assist device placement in pediatric patients have increased over time, with a concomitant increase in resource utilization. Age under 1 year, certain noncardiac morbidities, and the use of extracorporeal membrane oxygenation are associated with worse outcomes. Lower mortality was seen at larger volume ventricular assist device centers.

Elevation of serum cardiac troponin I in a cross-sectional cohort of asymptomatic subjects with Friedreich ataxia

BACKGROUND Troponin I is often obtained during the evaluation of a potential transplant donor heart. It is not clear whether elevations in donor troponin I levels predict adverse outcomes and should thus preclude acceptance of a donor heart. This study examined whether troponin I levels from donors accepted for pediatric heart transplantation predicted graft failure. METHODS Deidentified data on heart transplants performed in recipients aged < 21 years between April 2007 and April 2009 was provided by the Organ Procurement and Transplantation Network. Donor troponin I level and recipient outcomes, including survival without retransplantation (graft survival), were examined for statistical correlation. RESULTS Overall graft survival in 839 heart transplants was 81% at 2 years. At least 1 troponin I level was recorded in 657 donors before transplant, with a median value of 0.1 ng/ml (range, 0-50 ng/ml). Troponin I level and graft status were not correlated (p = 0.74). A receiver operating characteristic curve showed no association between troponin I and graft status (area under the curve, 0.51; p = 0.98). Graft survival did not differ significantly (p = 0.60) among quartiles of troponin I levels (<0.04, 0.04-<0.1, 0.1-<0.35, ≥ 0.35 ng/ml). A troponin I level ≥ 1 ng/ml was found in 74 transplanted donor hearts; graft survival was not associated with troponin I ≥ 1 (80%) vs < 1 (80%) at 2 years (p = 0.93). Troponin I values were not associated with post-transplant hospital length of stay (r = -0.06; p = 0.10). CONCLUSIONS In donor hearts accepted for pediatric heart transplantation, troponin I elevation before procurement is not associated with increased graft failure. The significance of elevated troponin I levels, which occurs in many heart donors, remains unclear and should therefore be considered in the context of other clinical information.