Publications by authors named "Elizabeth H Stephens"
Background: Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue impacting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality.
View Article and Find Full Text PDFObjectives: To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients.
Design: A retrospective cohort study.
Setting: A large academic medical system comprising four sites.
A Rare Case of Solitary Cardiac Myofibroma in an Infant.
World J Pediatr Congenit Heart Surg
January 2025
Article Synopsis
- Solitary myofibromas are rare, benign tumors mostly found in the head and neck, but this report focuses on an unusual case of a solitary cardiac myofibroma in an infant.
- A two-month-old was diagnosed with a 2×1 cm mass on the mitral papillary muscle, leading to severe heart regurgitation; imaging techniques were used to assess the mass.
- Surgical removal was performed and the patient recovered well, with follow-up showing no recurrence of the tumor and minor regurgitation issues.
Article Synopsis
- The study aimed to explore the health outcomes and factors relating to adults with a specific heart condition called partial anomalous pulmonary venous return with an intact atrial septum (PAPVR-IAS) that hasn't been surgically repaired.
- Researchers at the Mayo Clinic analyzed various clinical indicators and heart measurements in 80 patients over 3 to 5 years, comparing those with unrepaired PAPVR-IAS to those who underwent repair.
- They found that a newly developed risk score could predict the need for surgical intervention, and importantly, patients with unrepaired PAPVR-IAS showed no significant decline in their health or heart function over time.
Article Synopsis
- Limited data exist regarding the effects of cardiac surgery on pregnant individuals and their fetuses, prompting a study reviewing cases from 1978 to 2023.
- The study analyzed 29 pregnant patients undergoing cardiac surgery, revealing a maternal death rate of 3% and a fetal loss rate of 17%, with higher mortality in those undergoing surgery later in pregnancy.
- The findings suggest that cesarean delivery before surgery may help reduce fetal mortality if the fetus is viable, highlighting the need for careful planning in such cases.
Pediatric Quadricuspid Aortic Valve: Morphology, Characteristics, Clinical Outcomes, and Literature Review.
World J Pediatr Congenit Heart Surg
September 2024
Article Synopsis
PA-VSD Without MAPCA(s): Review of Long-Term Outcomes and Reinterventions.
World J Pediatr Congenit Heart Surg
July 2024
Article Synopsis
- Pulmonary atresia with ventricular septal defect (VSD) without major aortopulmonary collateral arteries (MAPCAs) is a rare congenital heart defect, with the study focusing on long-term outcomes as more patients reach adulthood.
- A review of studies from 1990 to now revealed that around 80% of patients survive ten years, and factors like complete repair and the size of pulmonary arteries significantly improve survival rates.
- Long-term challenges include the need for additional procedures on the right ventricular outflow tract, particularly if the pulmonary arteries are underdeveloped or if the initial repair was incomplete.
Article Synopsis
- Patients with congenital heart disease often require reoperative surgeries, especially for valve issues, and a study tracked 1960 adult patients undergoing repeat surgeries from 1993 to 2022 to analyze outcomes.* -
- Among the 502 patients studied, most underwent surgeries involving multiple valves, with low early mortality rates of 4.2%, particularly for elective operations.* -
- Key factors influencing mortality included patient age, heart function, and the urgency of the surgery, indicating that timely referrals can improve surgical outcomes.*
Article Synopsis
- Patients with adult congenital heart disease (ACHD) are increasingly facing heart failure, but there is limited research on their heart transplantation outcomes.
- A study analyzed 77 ACHD patients who underwent heart transplantation from 1990 to 2023, finding that univentricular (UniV) patients had higher rates of liver disease and required more multiorgan transplants compared to biventricular (BiV) patients.
- While UniV patients showed lower survival rates within the first year post-transplant, their long-term survival rates were comparable to BiV patients after one year, highlighting complex health challenges in this demographic.
Article Synopsis
- * Analysis of 50,625 operations showed that higher prior surgery counts (3 or more) significantly increased the risks: operative mortality rates rose from 0.6% for no prior surgeries to 6.3% for six or more.
- * The findings indicate that having three or more prior cardiopulmonary bypass operations is a strong independent risk factor for worse surgical outcomes, suggesting that further studies should focus on improving patient management and outcomes.
Article Synopsis
- Coarctation of the aorta is common in neonates and infants, but management guidelines for this condition are lacking, prompting a review by experts in congenital heart conditions.
- A panel used the PICO framework to develop practice guidelines, concluding that surgery is typically indicated for isolated coarctation unless there are specific surgery risks, while medical management may be considered for at-risk patients.
- The choice between thoracotomy and sternotomy for surgical intervention largely depends on the presence of arch hypoplasia, and further research is needed to improve management strategies for these patients.
Article Synopsis
- Limited data on the outcomes of delayed sternal closure (DSC) in adults with congenital heart disease have been gathered from a review of 159 patients over 30 years.
- Among the 112 patients undergoing DSC, those closed within 4 days had lower early mortality (6.8%) compared to those closed after 4 days (32%), and higher ages and specific medical conditions were linked to worse outcomes.
- Despite the risks, hospital survivors showed no significant difference in late survival between those with brief DSC (≤4 days) and prolonged DSC (>4 days), indicating that a shorter DSC duration may lead to better initial outcomes.
Heart Transplantation for Ebstein Anomaly due to Late Surgical Presentation.
World J Pediatr Congenit Heart Surg
September 2024
Article Synopsis
- - Ebstein anomaly is a rare heart condition affecting the right ventricle due to improper formation of the tricuspid valve, leading to tricuspid regurgitation.
- - The variability in symptoms and anatomy makes it tough to decide when to perform surgery, although modern techniques usually have low risks.
- - A case is discussed where a patient delayed surgery, underwent high-risk conventional procedures unsuccessfully, and ultimately needed a heart transplant.
Hypertrophic Cardiomyopathy: Preadolescence, Mitral Valve Disease, and Midventricular Obstruction.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu
March 2024
Septal myectomy is indicated in patients with obstructive hypertrophic cardiomyopathy (HCM) who have persistent symptoms despite medical therapy, intolerance of medication side effects, or severe resting or provocable gradients. Septal myectomy at high volume centers is safe, with low operative mortality (1%) and low rates of complications such as complete heart block or ventricular septal defect (3% and 0.5%, respectively).
View Article and Find Full Text PDFAortic valve disease is common, and valve-preserving operations are preferred whenever possible. Valve-sparing aortic root replacement (VSRR) has become an important tool for managing aortic root pathology in children and adults. The learning curve for this operation is challenging, but with increasing experience and technical modifications, early and late outcomes continue to improve.
View Article and Find Full Text PDFAortic valve disease is common, and valve-preserving operations are preferred whenever possible. Valve-sparing aortic root replacement has become an important tool for managing aortic root pathology in children and adults. The learning curve for this operation is challenging, but with increasing experience and technical modifications, early and late outcomes continue to improve.
View Article and Find Full Text PDFArticle Synopsis
- Routine defibrillation threshold testing (DFT) for implantable defibrillators (ICDs) has decreased, but follow-up defibrillation safety margin (DSM) testing is important for non-transvenous ICDs in pediatric patients and young adults.
- A study at Mayo Clinic involving 26 patients under 25 with epicardial ICDs examined DSM testing, showing a low rate of inadequate DSM results (3% for routine and 14% for clinically indicated tests).
- Findings indicate that while epicardial ICDs are generally reliable, DSM testing should focus on patients with specific clinical concerns rather than being routinely applied to all.
Invited Commentary: The Rarity of Ebstein Anomaly: A Case for Regionalized Care.
World J Pediatr Congenit Heart Surg
March 2024
Background: Although anomalous aortic origin of a coronary artery (AAOCA) is associated with risk of sudden cardiac arrest (SCA), there is a spectrum of disease, with the appropriate management for many remaining unclear. Increasing data warrant review for an updated perspective on management.
Methods: A panel of congenital cardiac surgeons, cardiologists, and imaging practitioners reviewed the current literature related to AAOCA and its management.
Background: Limited data exist regarding the long-term outcomes of systemic atrioventricular valve (SAVV) intervention (morphologic tricuspid valve) in congenitally corrected transposition (ccTGA).
Objectives: The goal of this study was to evaluate the mid- and long-term outcomes of SAVV surgery in ccTGA.
Methods: We performed a retrospective review of 108 ccTGA patients undergoing SAVV surgery from 1979 to 2022.
Background: Little is known about outcomes following heart failure (HF) hospitalization among adults with congenital heart disease (CHD) in the United States. We aim to compare the outcomes of HF versus non-HF hospitalizations in adults with CHD.
Methods And Results: Using a national deidentified administrative claims data set, patients with adult congenital heart disease (ACHD) hospitalized with and without HF (ACHDHF+, ACHDHF-) were characterized to determine the predictors of 90-day and 1-year mortality and quantify the risk of mortality, major adverse cardiac and cerebrovascular events, and health resource use.
Objective: Patients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac reoperation. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution.
Methods: Review of our institution's cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023.