PubMed Health⌕ Search

Biomedical subjects

Marshall L Jacobs

Publications and source records attributed to Marshall L Jacobs.

At least 19 recordsLinked to original sources
PubMed2006

Can pulmonary conduit dysfunction and failure be reduced in infants and children less than age 2 years at initial implantation?

OBJECTIVES: We sought to examine risk factors for pulmonary conduit failure or dysfunction in infants less than age 2 years at initial implantation. METHODS: From 2002 to 2005, 241 children at 17 institutions were discharged alive after initial pulmonary conduit insertion. Initial conduit type was pulmonary allograft in 37%, aortic allograft in 29%, bovine jugular venous valved conduit in 25%, porcine heterograft in 2%, and decellularized allograft in 7%. Parametric hazard analysis determined time-related prevalence and associated risk factors for pulmonary conduit intervention and explantation. Serial echocardiographic measurements after conduit implant were analyzed by mixed regression models. RESULTS: There were 89 first conduit-related interventions after discharge and 37 initial conduit explants were performed. First conduit intervention occurred at a constant rate, with a prevalence of 58% at 3 years from initial implant. Pulmonary conduit explantation (30% at 3 years) was characterized by an early-rising risk, suggesting that catheter-based intervention effectively blunts this early initial risk. Common risk-factors for first conduit intervention and explantation were smaller conduit Z-score and younger age at initial conduit implant, and the presence of pulmonary arborization abnormalities or stenoses. Pulmonary conduit peak gradient and regurgitation progressed nonlinearly in all patients over time. Gradient progressed more rapidly in children with aortic allografts and when initial conduit Z-score was less than +1 or more than +3. Pulmonary conduit regurgitation also progressed more rapidly in children with initial conduit Z-score greater than +3 and in those without jugular venous valved conduits, especially aortic allografts. CONCLUSIONS: Pulmonary conduit durability and hemodynamic function in patients undergoing initial conduit insertion at less than age 2 years can be improved by using pulmonary conduits with Z-scores between +1 and +3.

Blood Vessel Prosthesis↗
PubMed2006

Report of the 2005 STS Congenital Heart Surgery Practice and Manpower Survey.

BACKGROUND: Limited information is available concerning the congenital heart surgery workforce in North America. To obtain reliable data, The Society of Thoracic Surgeons (STS) Workforce on Congenital Heart Surgery undertook a subspecialty focused survey. METHODS: Preliminary research of websites and databases revealed a potential target group of 263 congenital heart surgeons, including 248 surgeons at 121 US centers and 15 at eight Canadian sites. Surveys were sent to these, plus any additional individuals who listed an interest in congenital or pediatric heart surgery on CTSNet or STS websites. Responders include active congenital heart surgeons, inactive, or retired surgeons, adult cardiac surgeons, and surgeons in training. Analysis is based exclusively on the responses of 217 active congenital heart surgeons (>80% of target). RESULTS: Average age was 48.3 +/- 8.3 years (range, 33 to 78). Ten were female (5%), 207 male (95%). American Medical School graduates were 170 (79%), with 9.2 +/- 1.6 years of postgraduate training. Eighty-five percent are Thoracic Board certified. Congenital heart surgery training outside the United States or Canada was obtained by 29 (14%). One hundred twenty-eight (59%) do exclusively congenital heart surgery. One third perform fewer than 100 congenital cases per year, one third perform 100 to 199, and one third perform 200 or more. Congenital heart surgeons have been in their current positions for 9.5 +/- 8.2 years. Eleven are in their first year of practice. Mean anticipated years to retirement is 15.7 +/- 7.5 (range, 1 to 34). Three anticipate retirement within 1 year. At the same time, 39 fellows will complete postgraduate training at 28 centers this year, and 19 will seek positions in North America. CONCLUSIONS: These data should help to facilitate rational plans to meet manpower needs, including evolving policies concerning training and certification.

Adult↗
PubMed2005

Matching procedure to morphology improves outcomes in neonates with tricuspid atresia.

OBJECTIVE: This study was undertaken to characterize morphologic substrate of tricuspid atresia with ventriculoarterial concordance and discriminate management strategies that lead to successful definitive repair. METHODS: From 1999 to 2004, a total of 150 babies with type I tricuspid atresia were enrolled from first diagnosis at 26 institutions. Antegrade pulmonary blood flow was absent in 19%, restricted in 54%, and unrestricted in 28%. Competing-risk methodology determined the time-related prevalence and risk factors for death versus cavopulmonary anastomosis and subsequent death versus Fontan completion. RESULTS: Overall 5-year survival was 86%. Initial palliation included systemic-pulmonary arterial shunt in 64%, pulmonary artery banding in 11%, and cavopulmonary anastomosis in 24%. Median age at cavopulmonary anastomosis was 6 months, with 83% undergoing bidirectional Glenn shunt and 17% undergoing hemi-Fontan procedure. By the age of 2 years, 89% had cavopulmonary anastomosis, 6% were dead, and 4% remained alive without cavopulmonary anastomosis. Risk factors for death without cavopulmonary anastomosis included presence of mitral regurgitation (P = .03) and palliation with systemic-pulmonary arterial shunts not originating from the innominate artery (P = .04). Factors associated with decreased transition rate to cavopulmonary connection included patient variables (younger admission age to a participating institution, noncardiac anomalies) and procedural variables (larger systemic-pulmonary arterial shunt diameter, previous palliation). Of patients undergoing cavopulmonary anastomosis, 75% had undergone a Fontan operation within 3 years. CONCLUSION: Smaller shunt size and decreased pulmonary blood flow decrease mortality after initial palliation and increase the rate of successful transition to cavopulmonary anastomosis. Outcomes can be improved by placing smaller shunts from the innominate artery, especially in patients with any mitral regurgitation.

Cardiac Surgical Procedures↗
PubMed2005

Current status of the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons Congenital Heart Surgery Database.

BACKGROUND: After utilizing separate congenital databases in the early 1990s, the Society of Thoracic Surgeons (STS) and the European Association for Cardio-Thoracic Surgery (EACTS) collaborated on several joint database initiatives. METHODS: In 1998, the joint EACTS-STS International Congenital Heart Surgery Nomenclature and Database Project Committee was created and a common nomenclature and common core minimum database dataset were adopted and published by the STS and the EACTS. In 1999, the joint EACTS-STS Aristotle Committee was created and the Aristotle Score was adopted and published as a method to provide complexity adjustment for congenital heart surgery. Collaborative efforts involving the EACTS and STS are underway to develop mechanisms to verify data completeness and accuracy. RESULTS: Since 1998, this nomenclature, database, and methodology of complexity adjustment have been used by both the STS and EACTS to analyze outcomes of over 40,000 patients. A huge amount of data have been generated which allow comparison of practice patterns and outcomes analysis between Europe and North America. The aggregate data from the first 5 years of data collection not only make for interesting comparison but also allow examination of regional difference in practice patterns. For example, in the EACTS, out of 4,273 neonates, 885 (20.7%) underwent arterial switch procedures and 297 (6.95%) underwent Norwood stage 1 procedures. In the STS, out of 3,988 neonates, 472 (11.8%) underwent arterial switch procedures and 575 (14.4%) underwent Norwood stage 1 procedures. CONCLUSIONS: This analysis of the EACTS-STS multi-institutional outcomes database confirms that in both Europe and North America, case complexity and mortality is highest among neonates, then infants, and then children. Regional differences in practice patterns are demonstrated, with the overall goal being the continued upgrade in the quality of surgery for congenital heart disease worldwide.

Databases, Factual↗
PubMed2005

Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study.

OBJECTIVE: We sought to determine the prevalence of outcomes and associated patient and management factors for neonates with interrupted aortic arch. METHODS: From 1987 to 1997, a total of 472 neonates were enrolled prospectively from 33 institutions. Competing risks methodology was used to determine simultaneous risk and associated incremental risk factors for death, initial and subsequent left ventricular outflow tract procedures, and arch reinterventions. RESULTS: Overall survival was 59% at 16 years after study entry but improved with successive birth cohort. In general, risk factors for death in each of the competing risks analyses included lower birth weight, younger age at study entry, type B interrupted aortic arch, and major associated cardiac anomalies. Of 453 patients who had interrupted aortic arch repair, after 16 years 33% had died and 28% had undergone an arch reintervention. Reintervention was more likely for those who had truncus arteriosus repair, interrupted aortic arch repair by a method other than direct anastomosis with patch augmentation, and the use of polytetrafluoroethylene as either an interposition graft or a patch. From study entry, competing risks after 16 years showed that 28% had died and 34% had undergone an initial left ventricular outflow tract procedure. Initial left ventricular outflow tract procedure was more likely for those with single ventricle, type B interrupted aortic arch, bicuspid aortic valve, or anomalous right subclavian artery. Among those who had undergone an initial left ventricular outflow tract procedure, after 16 years 37% had died and 28% had undergone a second procedure. CONCLUSION: Anatomic features affect mortality and initial left ventricular outflow tract procedures, whereas characteristics of the arch repair affect arch reintervention.

Aortic Arch Syndromes↗
PubMed2004

Total cavopulmonary connection to one lung.

The status of pulmonary circulation is of utmost importance to the success of the modified Fontan operation. Pulmonary artery distortion, hypoplasia of the total pulmonary vascular bed, and elevated pulmonary vascular resistance are all risk factors for adverse outcome after modified Fontan operations. In cases of irreparable acquired atresia of one or the other branch pulmonary artery, clinicians are forced to contemplate the possibility of total cavopulmonary connection to one lung. The combined experience of the authors with 12 cases suggests that the likelihood of operative survival following Fontan's operation to one lung is predicted based on the usual hemodynamic parameters: pulmonary artery pressure and flow, ventricular end diastolic pressure, transpulmonary gradient, and pulmonary vascular resistance. In this series, there were no operative mortalities among patients undergoing Fontan's operation to one lung, all of whom meet the usual criteria for hemodynamic acceptability. There may, however, be a higher incidence of protein-losing enteropathy than in Fontan patients with normal pulmonary vascular beds. All possible means of resuscitating the lost elements of the pulmonary vascular bed and re-establishing pulmonary artery continuity should be attempted to minimize pulmonary vascular capacitance of patients undergoing Fontan's operation. It is clear, however, that the presence of only one pulmonary artery does not in and of itself preclude satisfactory outcome.

Anastomosis, Surgical↗
PubMed2003

The hemi-Fontan operation.

In hearts with a functional single ventricle, cavity volume and myocardial muscle mass increase as a consequence of the excessive volume load associated with parallel pulmonary and systemic circulations. The hemi-Fontan operation was conceived as a means of accomplishing early reduction of the volume work of the single ventricle, in anticipation of eventual completion of a modified Fontan procedure. The hemi-Fontan procedure includes association of the superior vena(e) cava(e) (SVC) with the branch pulmonary arteries, augmentation of the central pulmonary arteries, occlusion of the inflow of the SVC into the right atrium, and elimination of other sources of pulmonary blood flow. Because it is preparatory to an eventual completion Fontan procedure, concomitant procedures are conveniently performed in conjunction with the hemi-Fontan. These may include atrial septectomy, relief of aortic arch obstruction, proximal main pulmonary artery to ascending aortic anastomosis, repair or revision of anomalous pulmonary venous connection, atrioventricular valvuloplasty, or other procedures.

Abnormalities, Multiple↗