Publications by authors named "James Kirklin"
Background: The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs).
Methods: From September 19, 2012, to December 31, 2023, there were 1648 devices in 1349 patients (<19 years) from 39 North American Hospitals with 100 patients enrolled in 2023.
Results: Cardiomyopathy was the most common underlying etiology (59%), followed by congenital heart disease (26%) and myocarditis (8%).
Analysis of diagnostic criteria for ECMO-associated pneumonia.
Infect Control Hosp Epidemiol
December 2024
Article Synopsis
- Ventilator-associated pneumonia (VAP) significantly impacts critically ill patients and contributes to high rates of illness.
- The existing criteria for diagnosing VAP do not apply to patients on extracorporeal membrane oxygenation (ECMO).
- This study analyzes the effectiveness of current VAP criteria for ECMO patients and evaluates a new proposed standard for diagnosing pneumonia in these individuals.
Early Outcomes for Management of Atrioventricular Septal Defect-Tetralogy of Fallot in the Last Decade: A Congenital Heart Surgeons' Society Study.
World J Pediatr Congenit Heart Surg
November 2024
Background: We sought to determine the management and early outcomes of complete atrioventricular septal defect-tetralogy of Fallot (AVSD-TOF) for a contemporary multicenter cohort.
Methods: Of 739 participants in the Congenital Heart Surgeons' Society AVSD cohort (January 2012-May 2021), 40 had AVSD-TOF. We first compared survival differences for patients with AVSD-TOF versus those with isolated AVSD using propensity matching.
Management of Tricuspid Atresia With Normally Related Great Arteries and Left-Sided Obstruction.
World J Pediatr Congenit Heart Surg
November 2024
Article Synopsis
- Tricuspid atresia (TA) is a heart condition affecting infants and is the second most common type of functionally univentricular heart, with rare cases of left ventricular outflow tract obstruction (LVOTO) in patients who have normally related great arteries.
- A study involving 445 patients with Type I TA showed that 3% of infants needed interventions for LVOTO, and most of those who underwent surgical procedures had promising outcomes.
- The long-term survival rate for these infants was estimated at 79% over 20 years, indicating that timely surgical management can lead to successful interventions and good heart function later in life.
The 15th Annual Report from The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support includes 29,634 continuous-flow left ventricular assist devices from the 10-year period between 2014 and 2024. The outcomes reported here demonstrate continued improved survival in the current era of fully magnetically levitated devices, with a significantly higher 1-year (85.7% vs 78.
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- Arrhythmias can cause severe heart issues in children, and when they are severe, heart transplantation (HTX) may be necessary, but this group has not been distinctively studied.
- *This study aimed to look at pediatric patients who needed HTX primarily due to malignant arrhythmia (MA) and how their outcomes compared to others on the list.
- *Out of thousands listed for HTX, only 63 patients (1.4%) had MA as the reason; although they were generally older and more likely to have had cardiac arrests, their chances of surviving and recovering after transplantation were similar to those without MA.
Article Synopsis
- - This study examined the incidence and risk factors for early stroke within the first week after the implantation of a left ventricular assist device (LVAD), revealing that 5.9% of patients experienced a stroke, with about half occurring in the initial 7 days post-surgery.
- - Key findings indicated that older age, having a temporary mechanical circulatory support (MCS) device, being of white race, and the presence of a left atrial clot before surgery were all associated with a higher risk of early stroke.
- - The study highlights the need for ongoing risk assessment and improvement strategies in the management of patients undergoing LVAD implantation to reduce early stroke occurrences.
Background: Studies evaluating the prevalence and impact of recurrent rejection (RR) in pediatric heart transplant (HT) are sparse.
Objectives: The purpose of this study was to describe prevalence and impact of RR on cardiac allograft vasculopathy (CAV) and graft loss after pediatric HT.
Methods: Data on HT from January 1, 2000, to June 30, 2020, in the Pediatric Heart Transplant Society database were included.
Article Synopsis
- The study investigates the use of mechanical circulatory support (MCS) in pediatric heart transplant patients, focusing on incidence, contributing factors, and outcomes based on a large database from 2010-2020.
- Among 4,321 primary heart transplants analyzed, 5.8% (249 patients) required MCS, with factors like congenital heart disease and older donor age linked to higher MCS need, while larger recipient size and better donor heart function correlated with lower needs.
- The one-year survival rate for patients requiring MCS was significantly lower at 54.2% compared to 94.8% for those without, but those who survived the first year had favorable long-term outcomes, suggesting selective use of MCS
Background: Few study authors examined factors influencing health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) implantation.
Objective: The purpose of this study was to determine whether 5 novel self-report measures and other variables were significantly associated with overall HRQOL at 3 months after LVAD surgery.
Methods: Patients were recruited between October 26, 2016, and February 29, 2020, from 12 US sites.
Background: The World Database for Pediatric and Congenital Heart Surgery (WDPCHS), sponsored by the World Society for Pediatric and Congenital Heart Surgery (WSPCHS), provides complex congenital heart surgery outcomes analyses for member programs. This report represents the seven-year descriptive analysis of outcomes from active members of the WDPCHS.
Methods: Individual institutions submit data based on the specific procedure via a password protected platform.
Background: Extending survival after heart transplant (HT) is of paramount importance for childhood recipients of HT. Acute rejection is a significant event, and biopsy remains the most specific means for distinguishing between cellular (ACR) and antibody-mediated rejection (AMR).
Methods: All children in the Pediatric Heart Transplant Society Registry who underwent HT between January 2015 and June 2022 and had ≥1 rejection episode were included.
Background: Patients have substantial variability in perioperative outcomes after left ventricular assist device (LVAD) implant. A perioperative multidimensional tool integrating mortality, adverse events (AEs), and patient-reported outcomes to assist in quality improvement initiatives is needed.
Methods: Patients undergoing HeartMate 3 LVAD implant (January 1, 2017 to January 31, 2024) in the Society of Thoracic Surgeons' Intermacs registry were studied.
Invited Commentary: Establishment of a Global Platform for the Treatment of Congenital Heart Disease by "Creation and Unification of National Congenital Heart Surgery Databases and Registries": It's Time!
World J Pediatr Congenit Heart Surg
November 2024
Background: Waitlist mortality (WM) remains elevated in pediatric heart transplantation. Allocation policy is a potential tool to help improve WM. This study aims to identify patients at highest risk for WM to potentially inform future allocation policy changes.
View Article and Find Full Text PDFBackground: Limited research exists on the influence of social determinants of health (SDOH) on outcomes in pediatric patients with advanced heart failure receiving mechanical circulatory support.
Methods: Linkage of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) and Society of Thoracic Surgeon's Congenital Heart Surgery Database (STS-CHSD) identified pediatric patients who underwent ventricular assist device (VAD) implantation from 2012 to 2022 with available residential zip codes. Utilizing the available zip codes, each patient was assigned a Childhood Opportunity Index (COI) score.
Background: The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) provides detailed understanding on pediatric patients supported with ventricular assist devices (VADs). We sought to identify important variables affecting the incidence of stroke in pediatric VADs.
Methods: Between 2012 and 2022, 1463 devices in 1219 patients were reported to Pedimacs from 40 centers in patients aged <19 years at their first VAD implantation.
Article Synopsis
- - The study evaluated the quality-adjusted life years (QALYs) in older heart failure patients (ages 60-80) who received either heart transplants (with or without pre-transplant mechanical support) or long-term mechanical circulatory support.
- - Data from 393 patients showed that those who underwent heart transplantation without pre-surgery support had significantly higher QALYs at 24 months compared to those who had pre-surgery support or long-term mechanical support.
- - Findings suggest that QALY assessments can guide healthcare policy and clinical decisions regarding the most beneficial treatment options for elderly patients with heart failure.
Background: Patient-reported outcome (PRO) measures of distinct concepts are often put together into patient profile assessments. When brief, profile assessments can decrease respondent burden and increase measure completion rates. In this report, we describe the creation of 5 self-reported 4-item short forms and the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) 20-item profile to assess PROs specific to adjustment and health-related quality of life (HRQOL) among patients who undergo left ventricular assist device (LVAD) implantation.
View Article and Find Full Text PDFBackground: Impacts of ischemic time (IT) on pediatric heart transplant outcomes are multifactorial. We aimed to analyze the effect of prolonged IT on graft loss after pediatric heart transplantation. We hypothesized that graft survival with prolonged IT has improved across eras.
View Article and Find Full Text PDFBackground: There are conflicting data regarding the relationship between center volume and outcomes in pediatric heart transplantation. Previous studies have not fully accounted for differences in case mix, particularly in high-risk congenital heart disease (CHD) groups. We aimed to evaluate the relationship between center volume and outcomes using the Pediatric Heart Transplant Society (PHTS) Registry and explore how case mix may affect outcomes.
View Article and Find Full Text PDFArticle Synopsis
- Heart transplantation for infants with hypoplastic left heart syndrome has seen significant success since the 1980s, with about 90% of children reaching their first year post-transplant thanks to advancements in clinical practices and research.
- Despite these improvements, challenges remain in ensuring long-term survival into adulthood, particularly due to high wait-list mortality and issues like cardiac allograft vasculopathy, which can lead to transplant failure.
- There is a need for targeted funding and research that addresses the unique risks faced by pediatric transplant recipients, as current funding heavily favors adult patients, limiting progress in pediatric care.
Background: The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), supported by The Society of Thoracic Surgeons, provides detailed information on pediatric patients supported with ventricular assist devices (VADs).
Methods: From September 19, 2012, to December 31, 2022, 1463 devices in 1219 patients aged <19 years were reported to the registry from 40 North American hospitals.
Results: Cardiomyopathy remains the most common underlying etiology (59%), followed by congenital heart disease (26%) and myocarditis (8%).
Background: Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure in pediatric heart transplant recipients (HTRs). Early statin use has been shown to reduce CAV incidence and all-cause mortality in adult HTRs. We sought to evaluate the contemporary prevalence and trends of statin use in pediatric HTRs and the association between statin use with CAV development and graft failure.
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