Smaller aortic isthmus size is associated with earlier surgical timing in complete common atrioventricular canal defects

Complete common atrioventricular canal (CAVC) heart defects are common, but data is limited regarding the relationship between patient-specific pre-operative characteristics and operative timing. The research team performed a retrospective, single-center review of all patients who underwent primary biventricular repair for complete CAVC defects between 2006 and 2015. Surgeons performed complete CAVC repair in 153 subjects at a mean age of 102 days. Aortic isthmus z-score on initial echocardiogram, pre-operative admission for heart failure, need for supplemental nutrition and lower birth weight were associated with earlier surgical repair. Evaluating early versus late repair, only aortic isthmus dimension was significant. Down syndrome, prematurity, use of diuretics, pre-operative atrioventricular valve regurgitation and aortic annulus size were not associated with surgical timing. Smaller aortic isthmus size, even without coarctation, is an important predictor of earlier surgical repair in complete CAVC. Although the timing of repair of CAVC is dependent on many factors, the relationship between aortic isthmus z-score and timing of surgery suggests that this measurement may be useful for providers in their initial counseling of families with regard to surgical timing. Danielle Burstein et al. "Smaller aortic isthmus size is associated with earlier surgical timing in complete common atrioventricular canal defects," presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018.


Emergency Department Visits Among Children with Congenital Heart Disease in the US

Children with congenital heart disease (CHD) presenting to the Emergency Department (ED) represent a medically complex population at increased risk for morbidity, mortality and resource utilization compared to those without CHD. The research team performed an analysis of data from the Nationwide Emergency Department Sample for 2006 to 2014. Patients age up to and including 18 years old with CHD were placed in one of three categories: simple CHD (atrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular canal defect); single ventricle; and other complex CHD. During the study time period, there were 41,196-48,501 annual CHD-related ED visits. Compared with non-CHD visits, those with CHD were more likely to be under one year of age, in an urban environment, in a teaching hospital and to pay with Medicaid. The most common presenting complaint was acute respiratory disease. More than 35 percent of CHD patients presenting to the ED had one or more complex chronic condition. Those with CHD were more likely to be admitted, and had higher median ED charges. Mortality was higher for CHD patients. Over nine years, there was an increase in median ED charge, while the mortality rate for CHD ED presentations decreased. This study better elucidates the number of CHD patients seen in the ED, details their medical complexity, examines risk factors for presentation to the ED and inpatient admission over time and describes temporal trends with respect to cost and mortality. Jonathan B. Edelson et al. "Emergency Department Visits Among Children with Congenital Heart Disease in the United States from 2006 to 2014," presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018

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