In Children's Heart Disease: Outcome Studies, Massage Therapy, Device Research, and More

ORLANDO, Fla., Feb. 27, 2016 /PRNewswire/ -- Pediatric cardiology researchers and clinicians from multiple centers worldwide are gathering at the Cardiology 2016: the 19^th Annual Update on Pediatric and Congenital Cardiovascular Disease conference, sponsored by The Children's Hospital of Philadelphia on Feb. 24 to Feb. 28 in Orlando, Fla. Among the many investigators presenting research at the event, the conference organizers chose eight clinical researchers as finalists for the Outstanding Investigator Award. The following news briefs summarize their presentations of research in congenital heart disease (CHD). All presentations occurred at the Loew's Royal Pacific Resort at Universal Orlando.

Using the CVP Score to Evaluate Fetal Hemodynamics
This study investigated the cardiovascular profile score (CVP), an echo-based multivariable tool that assesses fetal hemodynamics, in a multicenter cohort of fetuses with Ebstein's anomaly/tricuspid valve dysplasia (EA/TVD). Using a scale of 0 to 10, a CVP may help predict outcomes in fetuses with growth restriction and congenital heart defects. A previous pilot study showed that a CVP score under 7 was associated with poorer survival. The researchers performed a 23-center retrospective review of fetal echo data and outcomes in a cohort of 243 fetuses diagnosed with EA/TVD from 2005 to 2011. Evaluating the first and last fetal echo in gestation, the team found that fetuses with CVP scores below 7 on the first or last fetal echo were less likely to survive, suggesting that this score may be a valuable tool to help guide fetal counseling.
Freire GA, et al, All Children's Hospital; Prenatal Evolution of the Fetal Cardiovascular Profile Score in a Multicenter Study of Ebstein's Anomaly/Tricuspid Valve Dysplasia [abstract 36, Feb. 26, 2016]

Do Higher-Volume Centers Have Better Outcomes in Congenital Cardiac Catheterization?  
Although adults undergoing cardiac catheterization are known to have better outcomes in institutions that perform higher numbers of this procedure, less is known about outcomes in CHD patients. This study investigated the risk of a major adverse event (MAE) in patients with CHD. Drawing on the IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry, the researchers analyzed more than 56,000 cardiac catheterizations at 77 hospitals between 2011 and 2015. After multivariable adjustment, compared to low-volume programs, the odds of an adverse event were 0.55 at medium-volume programs (those with 150-299 annual procedures), 0.62 at high-volume programs (300-499 annual procedures), and 0.52 at very high-volume programs (over 500 annual procedures). Although the risk of MAE after cardiac catheterization in patients with CHD is low at all hospitals, it is significantly higher among lower-volume hospitals—those with fewer than 150 annual cases.
Jayaram NM, et al, Children's Mercy Kansas City; Relationship Between Hospital Procedure Volume and Complications Following Congenital Cardiac Catheterization: A Report from the IMPACT Registry [abstract 41, Feb. 26, 2016]

Anemia Is Prevalent in Children with Acute Heart Failure and Linked to Worse Outcomes
Although anemia is common in adults with heart failure, this was the first national evaluation of anemia in pediatric heart failure. The research team queried the Pediatric Health Information System database for all patients under age 19 admitted from 2004 to 2013 with acute decompensated heart failure and a diagnosis of cardiomyopathy. In the 2,968 patients meeting the study criteria, 19 percent had a diagnosis of anemia, and mortality was 10.2 percent. Patients with anemia had higher prevalence of ICU admission, mechanical ventilation, ventricular assist device placement, vasopressor or inotrope use, and longer length of stay. All these associations remained when controlling for packed red blood cell transfusion (PRBCT). After controlling for PRBCT, anemia was associated with mortality. Anemia is prevalent in this pediatric population and is associated with adverse outcomes.
Goldberg JF, et al, Baylor College of Medicine; Identifying the Prevalence and Effects of Anemia in Children Hospitalized for Acute Heart Failure: Analysis of a Multi-institutional Administrative Database [abstract 42, Feb. 26, 2016]

Massages May Benefit Children after Heart Surgery
This pilot study investigated approaches to treating pain and anxiety among children who underwent heart surgery. Researchers at Lucile Packard Children's Hospital Stanford and Cincinnati Children's Hospital Medical Center studied whether providing 30-minute sessions of massage therapy to children would reduce their need for opioids and benzodiazepines to address postsurgical pain and anxiety. The study team randomized 60 patients aged 6 to 19 into two groups—one receiving standard of care plus two to three sessions of massage therapy per week, other receiving standard care plus three 30-minute reading sessions during their hospitalization. The children who received massage therapy used less benzodiazepines in the first five post-operative days than those receiving reading. There was no difference in opioid exposure between the groups. This suggests that non-traditional forms of pain control may be useful in children undergoing heart surgery,
Staveski SL, Cincinnati Children's Hospital Medical Center; The Impact of Massage and Reading on Children's Pain and Anxiety after Cardiovascular Surgery: A Pilot Study [abstract 60 Feb. 26, 2016] 

20-Year Survival Rates in Single Ventricle Patients with Intact Fontan Circulation
This single-center study analyzed 20 years of experience and long-term outcomes in children who underwent the Fontan operation for single-ventricle disease at The Children's Hospital of Philadelphia between 1992 and 2009. The researchers investigated 773 patients meeting inclusion criteria, 49 percent of whom had hypoplastic left heart syndrome. Median follow-up was 8.9 years, with one-third of the cohort having follow-up greater than 15 years. The study team measured a composite outcome of death, transplant or Fontan takedown. Risk factors for early death or loss of Fontan were having a pre-1996 Fontan, post-operative pleural drainage greater than 14 days, prolonged ICU stay and longer aortic cross-clamp time. Risk factors for the late composite outcome were mild or greater AV valve regurgitation before Fontan and prolonged ICU stay. The overall survival with intact Fontan circulation was 74 percent. For patients surviving to one year, the conditional survival estimate was 79 percent at 20 years.
Downing TE, et al, The Children's Hospital of Philadelphia; Long-Term Survival with Intact Fontan Circulation in Single Ventricle Patients: Twenty Years of Experience at a Single Center [abstract 174, Feb. 26, 2016]

In Animal Studies, Novel Infant VAD Had No Device-Related Thromboembolism
This preclinical study investigated a ventricular assist device (VAD) for possible use in infants and small children with heart disease. Although a variety of VADs are available for adult patients, the only pediatric VAD device has troubling rates of thromboembolism, pump thrombosis and bleeding. The researchers developed a pulsatile infant VAD with the goal of minimizing thrombus formation and tested it in lambs, using low levels of the anticoagulant unfractionated heparin as a challenge test of thrombogenicity. All the animals completed the 60-day study duration with no clinical signs of thromboembolism. VAD flow was 1.2 plus or minus 0.2 liters/min, and blood chemistry values returned to normal within 2 weeks.
Clark JB, et al, Penn State College of Medicine; Development of a Non-Thrombogenic Infant Ventricular Assist Device [abstract 209, Feb. 26, 2016]

For Children with Out-of-Hospital Cardiac Arrest, Predictors of Survival, Public AED Use
This study analyzed patient- and neighborhood-level characteristics as predictors of survival and public AED use among pediatric patients who had out-of-hospital cardiac arrest. The researchers used prospectively collected data from the Cardiac Arrest Registry to Enhance Survival (CARES) for pediatric patients from 2005 to 2014, examining a cohort of 1,426 cases with a median age of 16. The overall survival of 16 percent was poor, but comparable to the rate in adults. The rate of public AED use remains low at 26 percent. Survivors were more likely to have their arrest witnessed, to be in a public location and to have a shockable rhythm. In addition, age was found to be the most powerful predictor of public AED use.
El Assaad I, et al, Cleveland Clinic Children's; Patient and Neighborhood Level Characteristics as Predictors of Survival in Pediatric Out-of-Hospital Arrests [abstract 223, Feb. 26, 2016]

What Factors Influence Maternal Outcomes in Pregnant Women with CHD?
Researchers performed a population-based analysis of maternal outcomes in women with congenital heart disease (CHD). Drawing on the Texas Inpatient Public Use Data File, the researchers studied discharges of pregnant women between 1999 and 2012. Of more than 5.3 million pregnancy-related discharges, 2,747 women had CHD. Compared to women without CHD, those with CHD had higher adverse maternal outcomes, including acute renal failure, cardiac arrest, ICU admissions, longer length of stay, and death. The heart lesions most associated with higher risk of adverse outcomes were ventricular septal defect/Eisenmenger and aortic valve disease. Pulmonary stenosis, tetralogy of Fallot, transposition of the great arteries and Ebstein anomaly were associated with minimal adverse events during the peripartum period.
Opina AD, et al, Baylor College of Medicine; Maternal Outcomes in Women with Congenital Heart Disease: A Texas Population-Based Study [abstract 225, Feb. 26, 2016]

Contact: Joey McCool Ryan
Phone: (267) 258-6735
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SOURCE The Children's Hospital of Philadelphia

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