2015 - Texas Children`s Hospital

2015
Texas Children’s Heart Center
6621 Fannin Street
Houston, Texas 77030
texaschildrens.org/heartoutcomes
texaschildrens.org/refer
©2016 Texas Children’s Hospital. All Rights Reserved. Heart233 060916
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Table of Contents
Welcome.
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Texas Children’s Hospital and
Baylor College of Medicine . .
. . . . . . . . . . . . . . .
Texas Children’s Heart Center
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Congenital Heart Surgery Service .
. . . . . . . . . . .
Heart Failure and Transplant Program .
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26
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29
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33
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36
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Preventive Cardiology Program .
Cardiovascular Anesthesia .
31
. . . .
Adult Congenital Heart Disease Program
Cardiovascular Intensive Care Unit.
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Cardiac Developmental Outcomes Program
41
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43
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44
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46
Outcomes and Impact Service.
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Medical Staff Directory
Publications .
Referrals
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19
Diagnostic Testing and Cardiac Imaging .
Leadership Team .
3
. . . . . . .
Interventional Cardiology
Electrophysiology .
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For access to Texas Children’s Heart Center outcomes
information, visit texaschildrens.org/heartoutcomes.
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Dear colleagues, parents and friends,
We are pleased to share with you the 2015 Texas Children’s Heart Center Outcomes Book. With
more than 900 operating room cases and over 25,600 patient encounters, this year has been full
of activity and growth. This report covers highlights from our Heart Center programs, including
incredible patient stories and important programmatic developments.
We continue to develop all of our Heart Center teams to better meet the needs of our patients
and families. In 2015, we welcomed several new physicians to our center, bringing the combined
Heart Center staff to over 125 providers.
Our facilities also continue to grow. We opened our first-of-its-kind Pediatric Heart Failure
Intensive Care Unit in 2015, aimed at providing highly specialized care for children with heart
failure, as well as those requiring intensive care before and after heart transplant, and those on
mechanical cardiac support.
Texas Children’s Hospital The Woodlands is in its final construction stages and remains on target
to open in 2017. We are actively recruiting a team to meet the specific needs of this community.
This will be Texas Children’s second community hospital and third pediatric hospital.
The main campus of Texas Children’s Hospital is also undergoing a $575 million expansion to
improve care and the patient/family experience in high-acuity areas such as surgery and intensive
care. In 2015, construction began on a pediatric tower that will be the new home to Texas
Children’s Heart Center, including the outpatient clinic, cardiovascular operating rooms and
catheterization labs. Slated for completion in 2018, the 25-floor tower will feature state-of-the-art
technology and 130 beds for pediatric and cardiovascular intensive care.
Texas Children’s Heart Center strives to provide every appropriate procedure available for
patients with pediatric and congenital heart disease. Through our innovations in research and
commitment to improving all aspects of patient care, our goal is to provide the very best possible
treatment for every patient.
We hope you enjoy reading about our outstanding team and their activities. Thank you for your
interest in our center.
Sincerely,
Charles D. Fraser, Jr., M.D.
Surgeon-in-Chief, Texas Children’s Hospital
Chief of Congenital Heart Surgery,Texas Children’s Hospital
Susan V. Clayton Chair in Surgery,Texas Children’s Hospital
Donovan Chair in Congenital Heart Surgery,Texas Children’s Hospital
Professor of Surgery and Pediatrics, Baylor College of Medicine
Daniel J. Penny, M.D., Ph.D., M.H.A.
Chief of Cardiology,Texas Children’s Hospital
Professor of Pediatrics, Baylor College of Medicine
Emad B. Mossad, M.D.
Director of Pediatric Cardiovascular Anesthesiology,Texas Children’s Hospital
Professor of Anesthesiology and Pediatrics, Baylor College of Medicine
Lara S. Shekerdemian, M.D., F.R.A.C.P., M.H.A.
Chief of Critical Care,Texas Children’s Hospital
Professor of Pediatrics, Baylor College of Medicine
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®
Texas Children’s Hospital and Baylor College of Medicine
Texas Children’s Hospital is one of the nation’s largest and most comprehensive specialty pediatric
hospitals, with more than 3.5 million patient encounters in 2015. Texas Children’s also operates
Texas Children’s Health Plan, the nation’s first health maintenance organization (HMO) created
just for children, and Texas Children’s Pediatrics, the nation’s largest primary pediatric care
network with more than 50 practices throughout the greater Houston community.
The main campus of Texas Children’s Hospital is located near downtown Houston in the Texas
Medical Center, the largest medical center in the world. The main campus includes nearly 500
licensed inpatient beds; the Clinical Care Center for outpatient visits; the Feigin Center for
pediatric research; and Texas Children’s Pavilion for Women, a comprehensive OB/GYN facility
with a focus on high-risk births. Located nearby is the Texas Children’s Hospital Jan and Dan
Duncan Neurological Research Institute, a basic research institute dedicated to solving childhood
neurological diseases. To serve the rapidly growing population in West Houston, Texas Children’s
Hospital West Campus opened in 2011 with acute care and critical care beds, an emergency
center, surgical suites and more than 20 subspecialty clinics. In 2017, a second community hospital,
Texas Children’s Hospital The Woodlands, will open.
The mission of Texas Children’s is to create a healthier future for children and women throughout
our global community by leading in patient care, education and research. Renowned worldwide
for our expertise and breakthrough developments in clinical care and research, Texas Children’s
Hospital ranked #4 among top children’s hospitals in the nation and ranked in all 10 pediatric
subspecialties in U.S. News & World Report’s list of America’s Best Children’s Hospitals.
Texas Children’s Hospital is affiliated with Baylor College of Medicine in the areas of pediatrics,
pediatric surgery, and obstetrics and gynecology. Baylor is ranked by U.S. News & World Report
as one of the nation’s top 10 medical schools for pediatrics. Currently and throughout our
61-year partnership, Texas Children’s Hospital serves as Baylor’s primary pediatric training site.
The collaboration between Texas Children’s Hospital and Baylor is one of the top five such
partnerships for pediatric research funding from the National Institutes of Health.
With a staff of more than 11,000 employees and more than 2,000 board-certified physicians,
pediatric subspecialists, pediatric surgical subspecialists and dentists, Texas Children’s offers more
than 40 subspecialties, programs and services.
Physicians are employees of Baylor College of Medicine, not Texas Children’s
Hospital. Because they practice at Texas Children’s Hospital, they may be
referred to as “our team” or “Texas Children’s physicians” throughout this report.
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Texas Children’s Heart Center is located in the hospital’s
main inpatient building, the West Tower, on floors 15 and
17 through 20. The close proximity of the Heart Center’s
treatment and administrative areas, perhaps unique in
pediatric cardiac care, enables team members to respond
quickly to patient and family needs or emergencies and
promotes collaboration among the multidisciplinary team.
2 0 t h F LO O R – Heart Center clinics and diagnostic
facilities, including the echocardiography lab and
cardiovascular clinical research core
19 t h F LO O R – Heart Center administrative offices
and conference rooms
15
18 t h F LO O R – 21-bed Cardiovascular Intensive
Care Unit; dedicated Heart Center pharmacy; three
state-of-the-art cardiovascular operating rooms;
three state-of-the-art cardiac catheterization labs;
eight-bed holding/catheterization recovery unit
17t h F LO O R – Cardiovascular Anesthesiology
administrative offices; Ronald McDonald ® Family
Waiting Room with additional private rooms for
families to consult with their child’s physicians or to wait
during procedures; support services, including social
work and child life staff
15t h F LO O R – 22-bed inpatient unit including six
“step-down” beds for patients who are healthy enough
to leave intensive care but still need close monitoring;
12-bed dedicated Heart Failure Intensive Care Unit
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Pioneers in Pediatric Cardiac Care
Texas Children’s Hospital has been a leader in pediatric heart care
for 60 years. Led by Denton Cooley, M.D., and Dan McNamara, M.D.,
the hospital started performing heart surgery in children in 1956.
Dr. McNamara, a patriarch of pediatric cardiology, and Dr. Cooley,
a pioneer heart surgeon, were among the first to demonstrate that
small children could safely undergo heart surgery.
Today, Texas Children’s Heart Center is one of the nation’s leading
providers of pediatric cardiac care. In 2015, U.S. News & World Report ranked
Texas Children’s Heart Center #2 in the nation for pediatric cardiology and heart surgery.
Comprising several multidisciplinary teams working in conjunction with pediatric subspecialists
throughout the hospital, the Heart Center strives to provide unparalleled care at every point from
diagnosis through treatment and follow-up.
Nº2
Texas Children’s Heart Center is part of the
OptumHealth Pediatric Transplant Centers of Excellence
Network and is recognized by Aetna as a Pediatric
Congenital Heart Surgery Institute of Excellence.
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National and International Reach
Texas Children’s commitment to caring for children reaches around the globe. In 2015, our
Heart Center cared for patients from more than 30 states and over 15 countries (shown below).
We are dedicated to creating a healthier future for children throughout the global community.
KUWAIT
QATAR
CAYMAN
ISLANDS
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2015
2015 Texas Children’s Heart Center Overview
Surgical procedures
Cardiac operations
Heart transplants
Lung transplants
Adult congenital heart disease operations
822
21
TOTA L
8
914
63
Cardiac catheterizations
Diagnostic cardiac catheterizations
544
Interventions
454
TOTA L
Electrophysiology studies and ablations
132
1,189
Pacemaker and defibrillator implants
59
Diagnostic testing and cardiac imaging
Echocardiograms
Fetal echocardiograms
Electrocardiograms
25,915
1,831
37,138
TOTA L
Cardiac MRIs
Stress MRIs
Holter ® monitors
Stress tests
509
71,483
41
5,118
931
Cardiovascular anesthesia
Catheterizations and electrophysiology patients
1,129
Cardiovascular operating room patients
982
TOTA L
Interventional radiology patients
252
2,791
MRI patients
428
The outpatient clinic at Texas Children’s Heart Center had more than 25,600 patient
encounters in 2015.
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Congenital Heart Surgery Service
The Congenital Heart Surgery Division provides individualized and comprehensive surgical care
for all aspects of pediatric and adult congenital heart disease. We are experienced in the rarest
of cases, such as ectopia cordis and other infrequently seen conditions. Texas Children’s Heart
Center performs more than 900 surgical procedures annually with outcomes among the best in
the country.
We treat children of all ages, including preterm and low-birth-weight newborns, and we
personalize treatments and procedures to best suit the situation of each child and family. This
tailored approach includes cardiopulmonary bypass and neuroprotection strategies focused on
the patient’s condition and needs, helping to achieve optimal functional outcomes. The center’s
Heart, Lung and Heart-Lung Transplant Programs, among the largest and most successful in the
United States, are also part of the Congenital Heart Surgery Division.
2 012
889
2 011
767
2 010
2 013
914
2009
836
2008
836
2 0 07
911
2006
816
769
Volume by year
928
Cardiovascular and thoracic surgery cases
781
8
2 014
2015
According to the Society of Thoracic Surgeons National Database Program, congenital
heart surgery programs are considered high-volume programs if they perform more
than 250 index operations per year on average.
Since 1995, Charles D. Fraser, Jr., M.D., and the Congenital Heart Surgery
team have performed more than 14,500 operations on children and
adults with congenital heart disease.
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Total cardiopulmonary bypass operations
CPB
914
928
305
331
889
340
2 012
2 013
609
549
284
2 011
483
2 010
597
2009
767
836
300
836
297
582
2008
536
2 0 07
539
2006
329
816
293
523
480
508
289
273
769
781
911
Volume by year
2 014
2015
NON-CPB
More than 64 percent of operations performed require the use of cardiopulmonary
bypass (CPB). Our incidence of mechanical circulatory support postcardiotomy is less
than 1 percent.
Cardiovascular and thoracic surgery cases
2011
2012
N E O N AT E
31.4%
6.9%
17.1%
4.0%
2013
I N FA N T
44 .6%
4 4. 5%
32 .9%
18.6%
5.1%
5.1%
7. 5%
16. 5%
18. 3%
19.9%
27.7%
30.4%
30.6%
45. 3%
46. 3%
47.4%
Percent by age
2015
2 014
CHILD
A D U LT
Our patients include children of all ages as well as adults who have been treated since
infancy or who have been diagnosed with a congenital heart defect later in life.
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2015
Mortalities by RACHS -1 classification in 2015
Number of
procedures
Number of
discharge
mortalities
Percent
mortality
STS
national
benchmark
Total for Risk Category 1
78
0
0.0%
0.4%
Total for Risk Category 2
240
1
0.4%
1.0%
Total for Risk Category 3
241
7
2.9%
3.2%
Total for Risk Category 4
60
0
0.0%
5.2%
Total for Risk Category 5-6
13
2
15.4%
13.4%
632
10
1.6%
2.9%
Primary procedure
Grand total
The Risk Adjustment in Congenital Heart Surgery (RACHS-1)1 categorization is a
widely used risk stratification model that analyzes outcomes in congenital heart surgery.
The most common surgeries for congenital heart defects are stratified into six risk
categories. Surgeries with higher risk are placed in higher categories with Category 6
representing congenital heart surgeries associated with the greatest risk.
1.6%
Overall risk-adjusted hospital mortality rate for our program in 2015
was 1.6%2. Data collected by the Society of Thoracic Surgeons (STS)
shows the national hospital discharge mortality rate at 2.9%3.
1
Jenkins KJ, Gauvreau K, Newburger JW, et al., Consensus-based method for risk adjustment for surgery for congenital
heart disease. J Thorac Cardiovasc Surg. 2002; 123:110-8.
2
007-RACHS-1 Index Surg CHD Volume.
3
Society of Thoracic Surgeons Data Harvest Report, published June 2015.
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2015
Mortalities by age and operation type in 2015
Age
CPB
cases
CPB
Non-CPB
Non-CPB discharge discharge Discharge
cases
mortalities mortalities mortality
STS
Percent
national
mortality benchmark
Neonate (0d - 30d)
68
39
2
3
5/107
4.7%
7.9%
Infant (31d - 1y)
175
30
2
0
2/205
1.0%
2 .8%
Child (>1y - <18y)
262
20
3
0
3/282
1.1%
1.1%
Adult (18y+)
38
0
0
0
0/38
0.0%
1.6%
Grand total
543
89
7
3
10/632 1.6%
2 .9%
Age-appropriate surgical planning and management allows for outcomes in patients of
all ages to be better than the national benchmarks. Patient total combines CPB and
non-CPB cases (N=632).
11
42
Atrial septal defect repair
27
22
2008
O V E R A L L H O S P I TA L
D I SC H A RG E
M O RTA L I T Y
R AT E 4
2010
2011
2012
2013
2014
<1%
Ventricular septal defect repair
2008
O V E R A L L H O S P I TA L
D I SC H A RG E
M O RTA L I T Y
R AT E 4
0%
S T S N AT I O N A L
BENCHMARK5
<1%
2 011
57
2 010
56
2009
60
54
2 0 07
53
53
59
70
Volume by year
2006
2015
The Congenital Heart Surgery Division performs an
average of 27 atrial septal defect (ASD) closures annually.
This includes patients with secundum, coronary, sinus
and sinus venosus ASDs. Our hospital survival rate is
100 percent. Our service also offers a minimally invasive
approach to ASD closure.
0%
S T S N AT I O N A L
BENCHMARK5
2009
82
2007
14
24
2006
14
23
32
35
Volume by year
39
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47
12
2 012
2 013
2 014
2015
Ventricular septal defects (VSD) are the most commonly
diagnosed congenital heart defects, and surgical treatment
remains the standard of care for children with this condition.
This data includes patients with perimembranous, supracristal,
inlet or muscular VSDs, and patients with double-chambered
right ventricle. The Congenital Heart Surgery Division performs
an average of 59 VSD closures each year and in 2015 had a
survival rate of 100 percent.
4
Hospital mortality is calculated over the last four years from 2012-2015.
5
STS benchmark data is from 2011-2014.
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Atrioventricular canal repair
O V E R A L L H O S P I TA L
D I SC H A RG E
M O RTA L I T Y
R AT E 6
2.0%
S T S N AT I O N A L
BENCHMARK7
2009
2 010
2 011
2 012
2 013
32
2008
33
2 0 07
20
2006
20
19
31
30
32
38
40
Volume by year
2 014
2015
The Congenital Heart Surgery Division performs an average
of 30 operations each year for partial, intermediate and
complete atrioventricular (AV) canal defects.
2.4%
Tetralogy of Fallot repair
21
2006
2 0 07
2008
O V E R A L L H O S P I TA L
D I SC H A RG E
M O RTA L I T Y
R AT E 6
1.0%
S T S N AT I O N A L
BENCHMARK7
1.6%
2009
2 012
31
2 013
24
2 011
22
30
2 010
27
31
27
35
42
Volume by year
2 014
Our surgical approach to the repair of tetralogy of Fallot
(TOF) is individualized for each patient based on age,
anatomy and symptoms. This allows us to attempt repair
of the defect while preserving critical parts of the cardiac
anatomy, thereby optimizing the patient’s cardiac function
over the long term. The Congenital Heart Surgery Division
performs an average of 29 TOF repairs each year.
6
Hospital mortality is calculated over the last four years from 2012-2015.
7
STS benchmark data is from 2011-2014.
2015
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Arterial switch operation
2009
16
2 010
2 011
2 012
2 014
2015
The arterial switch operation (ASO) is offered to patients
with simple transposition of the great arteries, complex
transposition of the great arteries and Taussig-Bing anomaly.
Historically, this operation has not been viewed as a
viable treatment option for some children due to their
size, complex coronary anatomy and associated cardiac
malformations. Our outcomes have demonstrated that
these characteristics are not associated with increased
operative risk. Our hospital survival rate is 100 percent.
0%
S T S N AT I O N A L
BENCHMARK9
2 013
10
2008
O V E R A L L H O S P I TA L
D I SC H A RG E
M O RTA L I T Y
R AT E 8
18
2 0 07
19
2006
14
12
15
16
29
29
Volume by year
4.1%
Norwood operation
2 013
2 014
10
17
21
17
2 0 07
17
2006
15
18
24
28
Volume by year
18
14
2008
O V E R A L L H O S P I TA L
D I SC H A RG E
M O RTA L I T Y
R AT E 8
16.9%
S T S N AT I O N A L
BENCHMARK9
2009
2 010
2 011
2 012
2015
The Congenital Heart Surgery Service performs an average
of 19 Norwood operations per year for hypoplastic left
heart syndrome and other single ventricle anomalies.
14.8%
8
Hospital mortality is calculated over the last four years from 2012-2015.
9
STS benchmark data is from 2011-2014.
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Single Ventricle Program
The Single Ventricle Home Monitoring Program and Outpatient Clinic at Texas Children’s Heart
Center is focused on the care of infants with single ventricle congenital heart defects, which include
hypoplastic left heart syndrome (HLHS) and variants, unbalanced atrioventricular septal defects,
complex single ventricle and heterotaxy syndrome, among others. Most of these infants will require
at least two or three operations within the first few years of life. The goals of these operations are
to: (1) allow free flow of blood from the heart out to the body; (2) protect the lungs from high
pressure and too much blood flow; and (3) create separate paths for blood to flow to the lungs and
out to the body. Infants will typically undergo placement of a shunt or conduit to provide blood flow
to the lungs within the first few days of life. For infants with HLHS, reconstruction of the vessel that
allows blood to flow to the body (the Norwood operation) is typically performed within the first
week of life. The second stage (bidirectional Glenn shunt) is performed at around 3-6 months of age.
The period between these operations is called interstage period.
The importance of a home monitoring program
The interstage period is an important phase in the infant’s well-being and outcome. It is common
for infants with single ventricle congenital heart defects to have poor oral intake and weight gain,
which may affect their well-being. They may require multiple daily medications, modified feeding
and interstage interventions. Common childhood illnesses, such as a cold or diarrhea, can be
life-threatening. Early recognition of signs and symptoms is thus necessary to be able to obtain
immediate evaluation and intervention. The home monitoring program allows parents and caregivers
to actively participate in the care of their babies outside of the hospital by watching for and
addressing many of the problems that can be seen in the interstage period. Our program provides
support, resources and clinical care to help transition successfully to the second surgery.
A team approach to treatment
Texas Children’s Congenital Heart Surgery team performs an average of 19 Norwood operations
a year for patients with HLHS and other single ventricle heart defects. We take a collaborative
approach to the post-surgical care of these infants drawing on the expertise of a multidisciplinary
team including Pediatric Cardiology, Congenital Heart Surgery, Interventional Cardiology,
Electrophysiology, Cardiac Imaging, Cardiovascular Anesthesia, Genetics and Nutrition Services.
Research and quality improvement
We are leaders in research involving the many
aspects of care of infants with single ventricle
heart disease, encompassing genetics, critical care,
nutrition and epidemiology. We are part of several
studies with the Pediatric Heart Network aiming to
further understand and address clinical questions.
Our program is also an active member of the
National Pediatric Cardiology Quality Improvement
Collaborative, a multicenter group focused on
improving quality and outcomes for children with
single ventricle heart defects who have undergone
a Norwood operation.
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Patient thrives after complex surgeries for congenital condition
Three surgeries and four years after a lifesaving open heart surgery, Stockton Watson is a
tenacious and energetic preschooler who recharges at naptime and takes only one medication –
a baby aspirin.
When his mother, Brittany, had a routine ultrasound at 14 weeks gestation, she learned Stockton’s
heart was abnormally shaped. An echocardiogram provided a diagnosis: hypoplastic left heart
syndrome (HLHS), a dangerous defect that stunts development of the left ventricle, mitral valve
and aortic valve, causing the left ventricle to be too small to function.
“The doctors told us HLHS was very serious and life-threatening for our baby,” she said. “It was
frightening, but we knew he would have to have surgery to correct the problem.”
Immediately, Brittany and her husband, Seth, began to research hospitals and surgical success rates.
To their surprise, that wasn’t as easy as they thought it would be.
“Most hospitals don’t give out figures, but Texas Children’s shared all the statistics,” she said. “It
confirmed that’s where we needed to be.”
HLHS typically requires a series of surgeries over the first several years of life. Between surgeries,
patients are monitored closely by the Single Ventricle Program.
Stockton weighed almost 8 pounds when he was born, and his first surgery was four days later.
He spent 11 days in the Cardiovascular Intensive Care Unit and 40 days as an inpatient.
“Those first few months were difficult, I have to admit,” Brittany said. “We would get over one
hurdle and another would pop up. But he was growing, and everything was progressing toward his
second surgery.”
Five months later, Stockton had the second procedure.
“This surgery gave us a whole new outlook,” Brittany said. “It really changed him, and he started
growing more quickly, crawling and talking.”
In 2015, when Stockton was 4, his doctors said he was ready for the next surgery. It too was a
success, and now the family returns for follow-ups only once a year.
Brittany says Stockton brings a great deal of love and happiness to their family, which includes an
older sister and younger brother and sister. He enjoys learning and is hitting – often exceeding –
developmental milestones.
Although it is likely Stockton will need a heart transplant as a young adult, he starts kindergarten
next fall with no restrictions except to avoid contact sports. Brittany has become an advocate
for people who are affected by HLHS as a member of the National Pediatric Cardiology Quality
Improvement Collaboration.
“We’re so grateful, and we know Texas Children’s was the right choice,” she said. “They have so
much experience and knew exactly what they were doing every step of the way.”
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Coronary Anomalies Program
In December 2012, Texas Children’s Hospital created the Coronary Anomalies Program, a
multidisciplinary team to care for patients with rare congenital heart defects associated with
coronary ischemia, myocardial infarction and sudden death. Coronary artery anomalies are the
second-leading cause of sudden cardiac death in children and young adults.
Diagnosing these anomalies can be challenging because many individuals with the conditions have
no symptoms, and their first manifestations can be sudden cardiac arrest or death. Those who do
have symptoms complain most often of chest pain, palpitations, dizziness or fainting during or just
after exercise.
How to best treat children or young adults with coronary artery anomalies is a subject of debate
in the medical community. Most physicians agree that surgery is necessary for patients who show
evidence of decreased blood flow to the heart tissue, but how to treat patients who have no
physical complaints and show no evidence of reduced blood flow to the heart is unclear.
Texas Children’s Hospital has hosted two conferences focused on this topic and is partnering
with the Children’s Hospital of Philadelphia to host the 3rd Symposium on Coronary Artery
Anomalies, which will be held in Philadelphia in 2016. During the conferences, speakers from
leading heart institutions across the country provide a dedicated forum to discuss the diagnosis
and management of patients with coronary artery anomalies.
Outcomes of patients with anomalous
aortic origin of a coronary artery
Texas Children’s Coronary Anomalies Program
began tracking outcomes in December 2012
and as of April 2016 has recorded:
Total patients
134
Surgery treatment
38
Surgical mortality
0
Complications
3
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Heart Failure and Transplant Program
Since its inception in 1984, Texas Children’s Heart Center has performed more than 335 heart
transplants, making it one of the largest and most successful programs in the nation. As the
number of diagnoses for pediatric heart failure has increased, so has our depth and breadth of
experience in treating patients, as has our ability to offer the right mechanical circulatory device
to support each child in heart failure. For more information on the Heart Transplant Program,
please visit texaschildrens.org/transplant.
Since 2011, Texas Children’s Heart Center has been an active member of the Pediatric Heart
Transplant Study, which is dedicated to the advancement of the science and treatment of children
during listing for and following heart transplantation. The purpose of the group is to establish
and maintain an international, prospective, event-driven database for heart transplantation, to use
the database to encourage and stimulate basic and clinical research in the field of pediatric heart
transplantation, and to promote new therapeutic strategies.
Mechanical circulatory support is often used as a bridge to transplantation in
children. At Texas Children’s Heart Center, we select a ventricular assist device
(VAD) from a variety of options to meet the needs of the individual patient.
VAD implantations10
By device
Thoratec P-VAD ®
11
Micromed ®
Impella ®
7
TOTAL CASES
3
153
HeartWare ®
17
Berlin Heart
EXCOR ® Pediatric
TandemHeart ®
3
46
®
SynCardia
Total Artificial Heart
1
HeartMate II ®
17
Rotaflow®
10
VADs placed from 1995-2015.
26
Bio-Medicus ®
22
19
20
H E A RT C E N T E R 2 0 1 5
Advancing the field of pediatric ventricular assist devices
In 2012, the United States Food and Drug Administration (FDA) granted humanitarian device
exemption for the Berlin Heart EXCOR® Pediatric Ventricular Assist Device (VAD). This approval
was the successful result of a multi-year, multi-institution study led by Texas Children’s Hospital.
This landmark event has opened the era of pediatric VAD support in North America. The Berlin
Heart EXCOR® is the only FDA-approved pediatric VAD.
Today, Texas Children’s Hospital continues to advance the field of pediatric ventricular assist
devices. Because there are significantly more adult patients with heart failure than pediatric
patients, device development is far more advanced in the adult world. Texas Children’s VAD
program strives to achieve improved outcomes by finding ways to utilize adult VADs in children.
These VADs include the HeartWare HVAD® and Impella catheter VAD®. Since HeartWare is
implantable, children on this device can live at home and even attend school. This has significantly
improved quality of life of patients compared to the Berlin Heart, which requires inpatient
management. Since 2012, Texas Children’s Heart Center has implanted 20 HeartWare and 11
Impella devices – more than any other pediatric center in North America. Our positive results
are widely recognized nationally and internationally, resulting in multiple publications.11,12,13
Jarvik Infant VAD
Texas Children’s Hospital is also working on the
development of a new-generation miniaturized
implantable VAD specifically designed for small children,
known as the Jarvik Infant VAD. With the support of
the federal government through the National Heart,
Lung and Blood Institute, this AA-battery-size device
is undergoing pre-clinical testing in a chronic animal
model, with the anticipation of FDA approval for a
human trial within 2016. This will further expand
the use of implantable VADs in small children,
including babies.
Extracorporeal life support
Extracorporeal life support (ECLS) is a treatment that helps support children when their heart
and/or lungs are unable to supply enough blood flow or oxygen to the body. This support may be
necessary after heart surgery or in some children with heart or lung disease. ECLS is provided
in the Pediatric Intensive Care Unit, Cardiovascular Intensive Care Unit or Neonatal Intensive
Care Unit based on each child’s underlying problem. A specially trained team of cardiac intensivists,
surgeons, critical care nurses and ECLS specialists carefully monitors each child’s condition.
To provide ECLS, we use extracorporeal membrane oxygenation (ECMO). With ECMO, blood
is pumped through the cannulae and into the machine oxygenating the patient’s blood. The
oxygenated blood is then returned through the circuit to the body, creating a continuous flow
and doing the work of the heart and/or lungs so the patient’s body can heal.
11
Adachi I, Guzmán-Pruneda FA, Jeewa A, Fraser CD Jr, Dean McKenzie E. A modified implantation technique of the
HeartWare ventricular assist device for pediatric patients. J Heart Lung Transplant. 2015 Jan; 34(1):134-6.
12
Asaki SY, Dean McKenzie E, Elias B, Adachi I. Rectus-sparing technique for driveline insertion of ventricular assist device.
Ann Thorac Surg. 2015 Nov; 100(5):1920-2.
13
Goldman J, Tume S, Jeewa A, Parekh D, Justino H, Adachi I. Impella use for left ventricle decompression in a 6-year-old
on ECMO Support: The youngest pediatric patient reported. ASAIO J. 2015; S90.
H E A RT C E N T E R 2 0 1 5
Heart transplants14
15
14
11
13
15
16
18
21
32
Volume by year
2007
2008
2009
2010
2011
2012
2013
2014
Heart transplant patient survival rates15
1 YEAR AFTER TRANSPLANT
7/1/12 TO 12 / 31/14 N = 4 7
T E X A S C H I L D R E N ’ S H E A RT C E N T E R
87. 50%
87. 51%
93.10%
92 .77%
95. 58%
96.88%
Pediatric age <18
3 YEARS AFTER TRANSPLANT
1/1/10 TO 6 / 3 0 /12 N = 2 9
S RT R E X P E C T E D
N AT I O N A L
14
Data includes patients who received heart-and-lung transplants simultaneously.
15
Scientific Registry of Transplant Recipients (SRTR). Program Specific Reports. Table 11 – srtr.org.
2015
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H E A RT C E N T E R 2 0 1 5
Heart transplant survival curves
The following graphs show the survival rates for patients by the number of years after heart
transplantation. The lines show the expected survival rates for our patients a number of years
after their transplant. Because these are estimates, the shaded areas show the 95 percent
confidence limits of the expected survival rates.
Survival curves16
By era
100%
80%
ERA III: 2005-2015
60%
Survival probability
22
40%
ERA II: 1999-2004
20%
ERA I: 1984-1998
0%
ERA I
ERA II
ERA III
82
62
172
50
41
65
36
28
7
29
8
0
16
0
3
0
5
10
15
20
25
30
Years post transplant
16
Wilcoxen test 1984-1998 vs. 1999-2004: p < 0.9975, 1984-1998 vs 2005-2015: p < 0.04, 1994-2004 vs. 2005-2015:
p < 0.0048.
Texas Children’s data: 1984-2015, 318 Txs on 318 patients, Age between 0 and 22 years.
UNOS data: 1987-2013, 7437 Txs on 6487 patients (3 observations missing data), Age between 0 and 17 years.
H E A RT C E N T E R 2 0 1 5
Survival curve vs. UNOS17
Era III (2005-2015)
100%
Texas
Children’s
Survival probability
80%
UNOS
60%
40%
20%
0%
Texas
Children’s
UNOS
151
2,909
90
1,690
64
1,011
38
475
14
75
0
0
0
2
4
6
8
10
Years post transplant
17
Wilcoxen test 1984-1998 vs. 1999-2004: p < 0.9975, 1984-1998 vs 2005-2015: p < 0.04, 1994-2004 vs. 2005-2015:
p < 0.0048.
Texas Children’s data: 1984-2015, 318 Txs on 318 patients, Age between 0 and 22 years.
UNOS data: 1987-2013, 7437 Txs on 6487 patients (3 observations missing data), Age between 0 and 17 years.
23
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H E A RT C E N T E R 2 0 1 5
One family fights breast cancer and heart failure
To say Riki Graves’ pregnancy was full of ups and downs would be a vast understatement. On her
38th birthday, just a few weeks after finding out that she and her husband, Chris, were expecting
their second child, Riki was diagnosed with breast cancer.
After consulting with doctors at MD Anderson Cancer Center, Riki made the deeply personal
decision to forego cancer treatments until after her baby was born. “I wanted to provide my
daughter with the strongest pregnancy and healthiest beginning to life possible,” she said.
Soon after that, during her 20-week ultrasound, the Graves family was dealt a second blow. They
found out that their unborn baby, a little girl whom they would name Juliana, had a serious heart
condition. Juliana was diagnosed with an unbalanced atrioventricular septal defect with severe
biventricular dysfunction, a small aortic arch and severe atrioventricular valve regurgitation.
Although the terminology meant little to her, Riki understood Juliana would likely need several
heart surgeries, and even then she might not survive. “Hearing those words sent a panic through
me that, even now, is hard to describe.”
Riki was referred to Texas Children’s Fetal Center.™ Nancy Ayres, M.D., director of Noninvasive
Imaging and Fetal Cardiology, and a multidisciplinary team provided care for mother and baby
during the pregnancy.
On April 9, 2014, Juliana was born weighing 6 pounds, 14 ounces. Charles D. Fraser, Jr., M.D., Texas
Children’s surgeon-in-chief and chief of Congenital Heart Surgery, determined that Juliana’s heart
was too structurally abnormal and not strong enough for surgery. Juliana was placed on the
transplant list on April 21. On April 26, at just 17 days old, she received a new heart.
“It is rare to find an organ for her size and age,” said Diana Orosco, R.N., a nurse coordinator
assigned to the Graves. “Historically, our center has not performed transplants on babies
this young.”
Jeffrey Heinle, M.D., surgical director of Texas Children’s Heart and Lung Transplant Program, led
the successful transplant surgery on Texas Children’s youngest heart transplant patient to date.
“We feel so fortunate that Juliana was cared for by Texas Children’s Hospital,” Riki said. “All the
doctors, fellows and nurses who provided extraordinary care and helped us get through – we
can’t thank them enough.”
Since her heart transplant, Juliana is doing fantastic. She recently celebrated her second birthday
and is developing typically.
After Juliana was born, Riki received radiation treatment at MD Anderson for her breast cancer
and has been in remission since July 2014.
H E A RT C E N T E R 2 0 1 5
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H E A RT C E N T E R 2 0 1 5
Interventional Cardiology
Thanks to advances in the field, an increasing number of heart conditions can be treated with
minimally-invasive catheter-based interventions. Texas Children’s Heart Center, the largest
program in the region to offer interventional cardiac catheterization for infants, children and
adolescents, performed 1,189 cardiac catheterization procedures in 2015. The full-service cardiac
catheterization laboratory performs interventions including:
• Balloon valvuloplasty
• Balloon angioplasty (using standard as well as “cutting” balloons)
• Stent placement (e.g. for pulmonary artery stenosis, coarctation of the aorta, etc.)
• Device closure of atrial septal defects, arterial and venous collaterals, coronary fistulae, etc.
• Device closure of patent ductus arteriosus, including in low-birth-weight and premature babies
• Transcatheter pulmonary valve replacement using the Melody® valve
In addition to these relatively common procedures, the Interventional Cardiology team at Texas
Children’s Hospital has developed cutting-edge treatment strategies for rare and debilitating
conditions such as:
• Pulmonary vein stenosis
• Venous thrombosis
• Multiple muscular ventricular septal defects (“Swiss cheese” septum)
• Congenital portosystemic shunts (Abernethy malformation)
• Pulmonary arteriovenous malformations (congenital and acquired)
• Pulmonary hypertension
• Renal artery stenosis
• Mid-aortic syndrome
• Critical aortic stenosis and hypoplastic left heart syndrome
In addition, we provide percutaneous ventricular assist device placement for heart failure (using
the Impella® device).
Despite being a regional and national referral center for the most complex forms of acquired
and congenital heart disease, our team has an extraordinarily low complication rate from
cardiac catheterizations (see chart on the following page). In addition, we have a strong culture
of attention to radiation safety and continuous quality improvement, and we strive to promote
these concepts locally and nationally. Our interventional team is actively involved in research into
new treatment strategies for congenital heart disease and is invited to lecture on these topics
nationally and internationally.
H E A RT C E N T E R 2 0 1 5
Cardiac catheterization laboratory complications
By rate
Cases without complications
96.20%
0.55%
Cases with
major complications
3.25%
Cases with
minor complications
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28
H E A RT C E N T E R 2 0 1 5
H E A RT C E N T E R 2 0 1 5
Electrophysiology
The Arrhythmia and Pacing Service at Texas Children’s Heart Center offers a broad complement
of diagnostic and therapeutic options to evaluate and manage heart rhythm abnormalities. We
have one of the highest volume pediatric centers in the country for invasive electrophysiology
studies and pacemaker/defibrillator implantations, and we maintain success rates for ablations
that exceed the national average. Innovation, research and experience have made Texas Children’s
Heart Center one of the leading centers in the world for the diagnosis and treatment of
arrhythmias in children and adults with congenital heart disease.
The Electrophysiology team runs a robust Genetic Arrhythmia Clinic. In 2015, there were more
than 500 patient visits for assessment of inherited arrhythmia syndromes, and the team is actively
involved in research to improve the management and outcomes of these patients. In collaboration
with the Cardiovascular Research Institute, work is underway to identify novel genes and the
molecular mechanisms that underlie arrhythmias and sudden death syndromes. Over the past year,
our group has discovered new insights into Wolff-Parkinson-White syndrome, catecholaminergic
polymorphic ventricular tachycardia, SCN5A overlap syndromes, Long QT syndrome and the
muscular dystrophies. Our research spans both the clinical and basic sciences, encompassing
a “bed to benchside” approach that strives to improve the overall care of our patients.
Supraventricular tachycardia ablation outcomes
2015
Texas Children’s Hospital
National benchmark18
A C U T E S U C C E S S R AT E
99%
95.2%
Stereotaxis
Texas Children’s Hospital is one of only a few hospitals in the U.S. with a remote magnetic
navigation (MN) system called Stereotaxis for catheter manipulation. Stereotaxis has been utilized
for over 150 ablation cases at Texas Children’s Hospital over the past several years.
MN offers theoretic advantages in the treatment of children. The catheter is more flexible and
atraumatic than standard catheters, potentially eliminating the risk of heart perforation. It can
also be navigated with more precision, allowing for movements as small as one millimeter or
deflections as small as one degree. This may result in enhanced accuracy and safety during mapping
and ablation of certain arrhythmias in this patient population.
Additionally, in order to decrease morbidity associated with radiation exposure during ablation
cases, the Arrhythmia and Pacing Service has established protocols utilizing non-fluoroscopic
mapping techniques to minimize radiation. This has resulted in a three-fold reduction in
fluoroscopy times, with over 100 procedures being performed with minimal radiation
(<1 minute) over the past two years (see graphs on the following page).
18
Based on data from the Pediatric Radiofrequency Catheter Ablation Registry. Kugler JD, Danford DA, Houston KA,
et al. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for
supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol. 2002 Apr; 13(4):336-41.
29
H E A RT C E N T E R 2 0 1 5
Changes in fluoroscopy time for ablation procedures
Fluoro time in minutes
By month
100
75
50
25
20
Ap 12
ril
20
Ju 12
n
20
1
Ju 2
l2
01
2
Se
p
20
1
N
ov 2
2
D 012
ec
20
Fe 12
b
20
M 13
ar
20
M 13
ay
20
Ju 13
n
20
Au 13
g2
01
N
ov 3
20
Jan 13
20
Fe 14
b
20
M 14
ar
20
Ju 14
n
20
Au 14
g2
0
O 14
ct
20
1
D
ec 4
20
Jan 14
20
Fe 15
b
20
Ju 15
n
20
1
Ju 5
l2
01
5
Au
g2
01
5
D
ec
20
15
0
Jan
30
Date of procedure
Mean and median of fluoroscopy time
By year
32 .89 (22 .87 )
25.17 (4.15,10 4.4)
2012
17.99 (19.85)
9.45 (0.0 0, 90.42)
2013
2014
2015
4.4 4 (6. 38)
1.91 (0.0 0, 32 .15)
3.62 (4 .77 )
1. 54 (0.0 0, 24 .68)
MEAN (SD)
MEDIAN (RANGE)
H E A RT C E N T E R 2 0 1 5
Diagnostic Testing and Cardiac Imaging
Each year, our noninvasive imaging lab performs more than 25,000 echocardiograms for fetuses,
infants, children and adults with congenital or acquired heart disease. The imaging lab provides
transesophageal, epicardial, intracardiac and transthoracic echocardiogram support in the
catheterization labs and operating rooms on a daily basis. The main echocardiography lab consists
of 10 rooms with a four-bed sedation bay and a state-of-the-art physician work area that houses
five reading stations.
Fetal echocardiograms
1,800
600
607
538
2015
946
899
1,000
767
1,200
953
1,400
800
2014
1,253
1,600
1,831
1,592
2,000
1,781
Volume by year
400
200
2006
2007
2008
2009
2010
2011
2012
2013
Fetal cardiac interventions
For some fetuses with cardiovascular conditions, fetal cardiac intervention is available at Texas
Children’s Hospital to try to improve the physiology of the heart before birth. Texas Children’s
Fetal Center™ at Texas Children’s Pavilion for Women is one of only a few centers in the world
capable of providing the full array of fetal cardiac interventions, which involves a coordinated
effort among a large, multidisciplinary team of fetal cardiologists, obstetricians and gynecologists,
interventional cardiologists, congenital heart surgeons, fetal imaging experts, maternal and fetal
anesthesiologists, and other clinical specialists. We offer the following fetal cardiac interventions:
• Fetal arrhythmia evaluation and treatment – While some abnormal fetal rhythm
problems are benign, others may result in fetal heart failure and can pose a risk to the fetus
and mother. We offer a variety of therapies that are customized for both the fetus and mother.
We collaborate closely with adult cardiologists to protect the safety of both fetus and mother
during treatment.
• Fetal hypoplastic left heart syndrome (HLHS) and related conditions – We offer
three fetal cardiac interventions for babies with small left heart structures, with the type of
therapy depending on the fetal heart anatomy.
31
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H E A RT C E N T E R 2 0 1 5
- For fetal aortic stenosis, which progresses to HLHS, we offer aortic valvuloplasty. This
procedure is performed by a multidisciplinary team and consists of placing a small balloon
across the fetal aortic valve to enlarge it and to promote blood flow through the left side
of the heart.
- For fetuses with HLHS or mitral valve dysplasia and a restrictive or intact atrial septum, we
offer fetal atrial septal intervention. For this procedure, either a balloon or stent is placed
across the atrial septum of the heart to decrease the pressure in the left atrium and to help
the fetal lungs recover before birth.
- For fetuses with small left-sided structures who may need neonatal heart surgery but do
not meet the criteria for the above procedures, we are conducting an experimental study
protocol in which we provide daily home oxygen to mothers, also known as maternal
hyperoxygenation, to promote fetal left heart growth.
Stress MRI
There is a growing need within pediatrics for the accurate assessment of myocardial perfusion
due to both acquired and congenital heart defects. At Texas Children’s Hospital, we are one of the
few pediatric centers in the country to offer stress MRI by multiple pharmacologic stress agents.
This technology has been shown to be superior to many other noninvasive modalities in the adult
population, and Texas Children’s Hospital is adopting many of these same principles and applying
them to the pediatric population. These examinations involve the dedicated and coordinated
efforts of a pediatric cardiologist, pediatric radiologist, cardiac pharmacologist, cardiac MRI
technician and MRI physicist.
H E A RT C E N T E R 2 0 1 5
Adult Congenital Heart Disease Program
The Adult Congenital Heart Disease (ACHD) Program at Texas Children’s Hospital offers a
single point of care for patients with congenital heart disease from birth to adulthood. Our
program offers the full range of ACHD services and specialties including surgery, diagnostic and
interventional cardiac catheterization, noninvasive imaging (including cardiac MRIs and coronary
CT angiography), arrhythmia services and more.
ACHD clinic encounters19
Volume by year
1, 556
2012
1,217
1,793
2013
1, 373
2 ,054
2014
1, 529
2 ,423
2015
1,782
CLINIC VISITS
PAT I E N T S
Congenital heart disease diagnoses of ACHD patients
In 2015
Other
11%
Atrioventricular
septal defect
20%
Tetralogy
of Fallot
12%
6%
Ventricular
septal defect
18%
9%
Coarctation
of the aorta
9%
Atrial septal
defect
19
Volumes reflect patients age 18 years or older.
15%
Single
ventricle
Transposition of
the great arteries
33
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Living life to the fullest, despite congenital heart condition
Falon Wiesner-Jones has spent 33 years defying the odds, including giving birth to two healthy
babies after she was told her chances to get pregnant were slim to none.
Diagnosed at 6 weeks old with transposition of the great arteries, a life-threatening heart defect,
Falon has had more than 15 procedures, including three open-chest surgeries at Texas Children’s.
At age 4, Falon had her first open heart surgery, performed by Denton Cooley, M.D., at Texas
Children’s. At 5, she received a pacemaker.
Although she couldn’t participate in contact sports, she did everything else – band, 4-H, ballet,
gymnastics, skiing – even cheerleading.
“My parents never babied me; they only encouraged me,” she said. “My mom always told me I
should go and live my life rather than watch it pass me by.”
When she was 16, Falon learned she had Stage II heart failure. Although she feels healthy most of
the time, it is a condition that requires a lifetime of careful maintenance.
During college at Texas A&M University, Falon fell in love with her husband, Chad. Following
graduation, they moved to New York and then Dallas. Falon has had two major complications and
surgeries in adulthood.
At 28 years old, Falon transitioned to Texas Children’s Adult Congenital Heart Disease (ACHD)
Program for specialized follow-up care for her condition.
“I’ve been at Texas Children’s since day one, and they really know me and my entire history,” Falon
said. “It is so reassuring to be able to continue my care here, and to have all the resources I need
in one spot.”
When Falon became pregnant with her first child, the ACHD team and Texas Children’s Pavilion
for Women maternal-fetal medicine specialists worked hand-in-hand and closely monitored the
condition of both mother and child.
“In the past, we used to tell women who had grown up with congenital heart disease not to
get pregnant,” said Wayne Franklin, M.D., director of Texas Children’s Adult Congenital Heart
Disease Program. “But we have since found that with excellent cardiology care and maternal-fetal
medicine, these patients can have good outcomes with their pregnancies.”
After delivering a healthy baby girl in 2011, Falon went on to have a healthy son in late 2015.
“I have been very fortunate, and there isn’t a day that goes by I don’t thank God for my blessings,”
she said. “I may still have many obstacles to face in the future, but with the help of Texas
Children’s I am looking forward to seeing my children grow up and accomplish their dreams.”
H E A RT C E N T E R 2 0 1 5
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H E A RT C E N T E R 2 0 1 5
Preventive Cardiology Program
The Preventive Cardiology Program at Texas Children’s Heart Center is part of our mission to
provide the best possible care and outcomes for our patients. Focused on medically managing
the risk factors of acquired heart disease in children, the Preventive Cardiology Program cares
for patients with a strong personal or family history of cardiac disease, elevated cholesterol, high
blood pressure or Kawasaki disease. Our goal is to prevent future cardiac disease and events such
as heart attack and stroke through early detection and intervention and by educating children and
families on how to better care for themselves.
Abnormal cholesterol and high blood pressure are well recognized conditions in adults. It
surprises many people that these conditions can also arise in childhood, and that they lay the
foundation for heart disease in adulthood. Research shows that normalizing cholesterol values
and reducing high blood pressure in children may help prevent or slow the development of heart
disease as they reach adulthood.
The goal of the Preventive Cardiology Program is to prevent heart attack, stroke and other
acute cardiac events later in life, to decrease mortality and to increase a child’s future quality of
life. Typically, our patients have abnormal cholesterol levels or high blood pressure or have been
diagnosed with Kawasaki Disease, which can increase the risk of cardiac disease in adulthood.
Our patients may have other conditions such as liver disease, obesity, diabetes or metabolic
syndrome that directly cause cholesterol or blood pressure abnormalities. Others, perhaps
through a poor diet, lack of physical activity or other lifestyle factors, may be at a higher risk for
cardiac disease and on an early pathway to acquired heart disease in adulthood.
With more than half a century of leadership in the care of patients with congenital heart
disease, Texas Children’s has pioneered many of the now-standard procedures and therapies
in pediatric cardiovascular care. The Preventive Cardiology Program uses a collaborative
approach to treating patients, drawing on the expertise of a multidisciplinary team of specialists,
including experts in pediatric cardiology, heart disease prevention, physical activity, nephrology,
endocrinology and nutrition.
H E A RT C E N T E R 2 0 1 5
Cardiovascular Anesthesia
Pediatric Cardiovascular Anesthesia at Texas Children’s Hospital provides sedation and anesthesia
services for all congenital cardiac operations and for children with congenital heart disease
undergoing various non-cardiac procedures. Services are also provided for catheterization and
electrophysiology procedures as well as imaging studies in MRI, CT and interventional radiology.
Cardiovascular anesthesia cases
2011
2012
2 013
982
1,129
1,002
1,094
2 014
252
428
152
184
430
462
910
880
839
924
109
125
347
375
855
955
By location
2015
MRI
I N T E RV E N T I O N A L R A D I O L O G Y
C O N G E N I TA L H E A RT S U R G E RY O P E R AT I N G RO O M S
C AT H E T E R I Z AT I O N A N D E L E C T RO P H Y S I O L O G Y
The Pediatric Cardiovascular Anesthesia Division treated more than 2,700
patients in 2015. Beyond anesthetic care, the division actively participates in
the daily care of patients in the Cardiovascular Intensive Care Unit.
37
H E A RT C E N T E R 2 0 1 5
Reduction in cryoprecipitate waste in the pediatric cardiovascular
operating room: A goal-directed transfusion pathway
In the United States, although the volume of blood and blood products needed for surgeries
continues to increase annually, the amount of blood donated annually remains the same. Thus, it is
important for health care organizations to responsibly manage blood/blood products and reduce
the amount wasted in the OR due to over-ordering or over-estimating need. Texas Children’s
Pediatric Cardiovascular Anesthesia Division recently embarked on a quality improvement project
led by Erin Gottlieb, M.D., to introduce a goal-directed transfusion pathway based on results from
rotational thromboelastometry (ROTEM®) and to limit the waste of cryoprecipitate, a blood
product used to treat coagulation abnormalities in congenital heart surgery that was identified
as highly vulnerable to waste.
The graphs below show a sustained decrease in cryoprecipitate waste after education and
implementation of the transfusion pathway, along with a corresponding increase in the use of
ROTEM® and fibrinogen concentrate (substitute for cryoprecipitate). The results were recently
presented at the Congenital Cardiac Anesthesia Society and Society for Pediatric Anesthesia
meetings and since then, multiple peer institutions have implemented similar measures in their
CVORs. Texas Children’s Heart Center has found this pathway to be effective at reducing wasted
blood as well as cryoprecipitate and is using it in cardiovascular surgeries.
Cryoprecipitate waste in the CVOR
By month
80
Units wasted
70
60
UCL
50
40
30
LCL
20
10
December
November
October
September
August
July
June
May
April
March
February
January
2015
December
November
October
September
2014
0
In 2015
45
8
40
7
35
6
30
5
25
4
20
3
15
10
2
5
1
0
0
March
April
May
June
July
August
September
October
November
December
NUMBER OF ROTEM® ORDERED
NUMBER OF PATIENTS WHO RECEIVED FIBRINOGEN CONCENTRATE
Number of patients who received
fibrinogen concentrate
ROTEM ® and fibrinogen concentrate trends
Number of tests ordered
38
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Early extubation in the pediatric cardiac operating rooms
Early extubation in the cardiac operating rooms can have a positive impact on patient outcomes,
including reducing the risk of pneumonia, infections and other complications and improving
patient comfort. Texas Children’s Hospital participated in a multicenter quality improvement
project to create clinical practice guidelines (CPG) to try to shorten the length of time patients
spend on a ventilator following two types of surgeries: tetralogy of Fallot and coarctation repair.
Teams from five leading pediatric heart centers looked into the factors that contribute to longer
ventilation periods and created guidelines to help address these issues. The centers then adopted
standardized guidelines and evaluated the changes in outcomes in the OR and the ICU. At Texas
Children’s, the anesthesia portion of the project was led by David F. Vener, M.D., and included
teams from Cardiovascular Anesthesia, the Cardiovascular Intensive Care Unit, Cardiovascular
Surgery and Nursing, among others. The guidelines resulted in a significant reduction in time to
extubation and ICU length of stay at all participating centers. At Texas Children’s, the mean hours
of ventilation went from 66 hours to 5.5 hours following adoption of the CPG for patients with
tetralogy of Fallot, and the mean length of stay in the CVICU went from 6.2 to 4.2 days. For
coarctation, the mean hours of ventilation went from 21.2 hours to 12 hours following adoption
of the CPG, and the mean length of stay in the CVICU went from 5 days to 4.8 days.
Tetralogy of Fallot
ICU length of stay (days)
Post-op ventilation (hours)
250
35
30
Pre CPG
200
25
150
20
15
100
10
50
5
0
0
ICU length of stay (days)
Post CPG
Post-op ventilation (hours)
250
40
200
30
150
20
100
10
50
0
0
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Leaders in cardiovascular anesthesia education
Transesophageal Echocardiography for Congenital Heart Disease, edited by Texas
Children’s physicians Pierre C. Wong, M.D., and Wanda C. Miller-Hance, M.D.,
focuses on the application of imaging modality in patients with congenital
heart disease. Published in early 2014, this book provides practical and
instructive information, supplemented with figures/illustrations and highquality videos. It is a resource for clinicians and trainees who wish to obtain
basic knowledge or advance their understanding of the field.
Gregory’s Textbook of Pediatric Anesthesia introduces the basics of the field
and explains how they are applied to contemporary practice both in and
out of the operating room. Co-edited by Dean B. Andropoulos, M.D., chief
of Anesthesiology at Texas Children’s Hospital, the book uses an evidencebased approach and is supplemented by in-depth case studies that spotlight
best practices in action across all the major subspecialties. It also contains
extensive information on anesthesia care for patients with congenital
heart disease.
Anesthesia for Congenital Heart Disease, edited by Dean B. Andropoulos, M.D.,
Stephen A. Stayer, M.D., Emad B. Mossad, M.D., and Wanda C. Miller-Hance,
M.D., is the leading textbook in the field of pediatric cardiac anesthesia. Now
in its 3rd edition, this textbook contains information on the rapid advances
in surgery and anesthesia for congenital heart disease that have occurred in
recent years, including neonatal cardiac surgery and anesthesia, treatment of
single ventricle patients, new diagnostic modalities and developments in the
catheterization laboratory. It also addresses mechanical support of circulation,
embryology and quality/outcomes management.
Following the inaugural American Board of Anesthesiology Pediatric
Anesthesiology subspecialty board exam, Texas Children’s Hospital is now
home to more than 60 subspecialty board-certified pediatric anesthesiologists.
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Cardiovascular Intensive Care Unit
The Cardiovascular Intensive Care Unit (CVICU) includes cardiac intensivists, advanced practice
providers, nurses, respiratory therapists, social workers, dietitians and support staff who provide
intensive care to newborns, infants, children and young adults with congenital and acquired heart
disease. With a total of 33 beds, the CVICU cares for patients undergoing surgery for congenital
and acquired heart disease, as well as those with end-stage heart failure before and after heart
transplantation. This year, in partnership with Cardiovascular Surgery, Heart Failure and
Interventional Cardiology, we expanded our mechanical support program to include the
largest pediatric utilization of a novel device, the Impella.®
New Heart Failure Intensive Care Unit
In July 2015, the CVICU launched the Heart Failure Intensive Care Unit, the first of its kind in
the nation. This highly specialized 12-bed unit focuses on the treatment of children with heart
failure, as well as those requiring intensive care before and after heart transplant, and those on
mechanical cardiac support.
Renowned faculty and training programs
CVICU faculty includes leaders in pediatric cardiac intensive care, with certification in pediatric
critical care, pediatric cardiology and pediatric anesthesiology. Texas Children’s also has the
largest dedicated CVICU advanced training program in the country. The Pediatric Cardiac Critical
Care Instructorship is a 12-month didactic and clinical training program for individuals who
have completed fellowships in pediatric critical care medicine or pediatric cardiology and wish
to pursue an additional year of training in pediatric cardiac intensive care. This training program
provides a unique interface among critical care medicine, cardiology, cardiothoracic surgery and
cardiac anesthesia. Texas Children’s also offers a fourth year of specialized training in neonatal
cardiac critical care. The first of its kind in the nation, this program provides one position each
year to neonatologists who desire additional training in newborn critical heart disease.
The opening of the Heart Failure Intensive Care Unit.
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Nursing care in the Cardiovascular Intensive Care Unit
The CVICU at Texas Children’s Hospital has 106 specialized pediatric intensive care registered
nurses on staff. The hours per patient day equivalent in the CVICU are 22.52 compared to the
national benchmark of 26.16. Benchmark data is pulled from Children’s Hospital Association of
like units. All newly admitted surgical cases receive a minimum ratio of 1:1 nursing care. More than
95 percent of the CVICU registered nurses have a bachelor’s degree in nursing with a 22 percent
rate of attainment of certification in critical care nursing.
Cardiology Patient Care Unit
The Cardiology Patient Care Unit is a 22-bed mixed intermediate and acute care unit caring for
newborns, infants, children and young adults with heart disease. The unit is staffed by pediatric
cardiologists, as well as a team of cardiology fellows, cardiac advanced practice providers, medical
residents and cardiac trained registered nurses. In 2015, there were 1,222 patient encounters
in this unit.
Nursing care in the Cardiology Patient Care Unit
The Cardiology Patient Care Unit at Texas Children’s Hospital has 54 registered nurses on staff.
The hours per patient day equivalent in the acute care unit are 13.7, compared to the national
benchmark of 15.9. The unit has a 65 percent rate of attainment for certification in pediatric
nursing. Almost 90 percent of the cardiology acute care registered nurses have a bachelor’s
degree in nursing, with the remaining 11 percent currently pursuing their bachelor’s degree
in nursing.
Cardiovascular Simulation Program
Texas Children’s Heart Center developed an in-situ simulation program in 2012 to ensure
nurses are prepared for patient emergencies and other high-risk clinical scenarios. The goals
of the program are to improve patient safety through early identification of patient issues and
to improve crisis resource management and teamwork skills. Program leaders established a
curriculum and learning matrix in order to track objectives and progress. In 2015, the in-situ
simulation room provided over 300 learning opportunities on the cardiology floor.
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Cardiac Developmental Outcomes Program
Until recently, most neurodevelopmental follow-up of congenital heart disease patients has been
in the context of research studies. Texas Children’s Heart Center’s Cardiac Developmental
Outcomes Program focuses on medical, social and developmental health in order to help children
reach their maximum potential.
Launched in April 2013, the program was created to provide routine neurodevelopmental
assessments and referrals for babies and children with congenital heart disease who have
undergone early surgery. Since the program’s creation, the team has assessed 375 babies and
children and provided referrals to a variety of specialists including speech and language, hearing,
neurology and behavioral experts.
The team includes developmental pediatricians and psychologists who work with the Heart
Center to identify any problems at the earliest possible stage. This provides an opportunity for
early intervention in order to minimize the impact of issues during childhood.
The program provides family-centered care, in which the child’s parents or caregivers are directly
consulted and involved in their child’s assessment and interventions for developmental progress.
We also help families find resources in their communities that support their child’s development.
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Outcomes & Impact Service
The Outcomes & Impact Service at Texas Children’s Hospital measures important clinical
outcomes and the impact of care on the quality of life and functional status of our patients over
time. The team’s goal is to deliver the highest value of health care to the patient.
By tracking outcomes, we learn about what happens to our patients, and we also learn about our
performance as a health care delivery organization. We know we must continue to strive toward
excellence in care delivery. In addition to providing statistics, we strive to engage patients and
families in a conversation about the choices they face that will impact their health.
Our team includes outcomes nurses dedicated to different clinical specialties, computer
programmers, data architects and specialists, and a statistician who works closely with clinical
and administrative teams to measure, improve and share our outcomes. The goals of our service
are to:
• Track and improve our clinical outcomes
• Understand the impact of those outcomes on the lives of our patients and families over time
• Make our outcomes data available in a form accessible by the general public
• Partner with patients and families in understanding outcomes data
• Help patients and families know what questions to ask when seeking medical treatment
For more information, please visit texaschildrens.org/outcomes-and-impact-service.
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Meet Our Leaders
Charles D. Fraser, Jr., M.D., is surgeonin-chief, co-director of Texas Children’s
Heart Center and chief of the Congenital
Heart Surgery Division at Texas Children’s
Hospital. His academic appointments include
professor of Surgery in the Michael E.
DeBakey Department of Surgery (tenured)
at Baylor College of Medicine, professor
of Pediatrics at Baylor College of Medicine
and adjunct professor of Bioengineering at
Rice University. Dr. Fraser holds the Clayton
Chair in Surgery and the Donovan Chair in
Congenital Heart Surgery at Texas Children’s
Hospital. Dr. Fraser has a clinical appointment
at the Texas Heart Institute, where he serves
as director of the Adult Congenital Heart
Surgery Program.
Dr. Fraser’s education began as an
undergraduate at the University of Texas
at Austin, where he graduated with honors
in mathematics. He received his medical
degree with honors from the University
of Texas Medical Branch at Galveston. His
residency and fellowship training took place
at The John Hopkins Hospital. He completed
additional fellowship training in congenital
heart surgery at the Royal Children’s Hospital
in Melbourne, Australia. After joining the
faculty at Cleveland Clinic, Dr. Fraser was
recruited to Texas Children’s Hospital in
July 1995 to establish a dedicated pediatric
congenital heart surgery program.
Daniel J. Penny, M.D., Ph.D., M.H.A.,
is chief of Cardiology at Texas Children’s
Hospital, co-director of Texas Children’s
Heart Center and professor of Pediatrics
at Baylor College of Medicine. Dr. Penny
obtained his medical degree from the
National University of Ireland and received
a doctoral degree for his thesis, “Functional
Analysis of Fontan Circulation,” from
the University of London. He completed
fellowship training in pediatric cardiology at
the Royal Children’s Hospital in Melbourne
and received a second doctoral degree at
Monash University, Australia, for his studies
on neonatal circulation. Dr. Penny worked as
a pediatric cardiologist at the Royal Brompton
Hospital and Great Ormond Street Hospital
in London. Before coming to Texas Children’s
Hospital, he was the chief of Cardiology at the
Royal Children’s Hospital of Melbourne and
a professor in the Department of Pediatrics
within the University of Melbourne.
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Emad B. Mossad, M.D., is director of
Pediatric Cardiovascular Anesthesiology at
Texas Children’s Hospital and co-director of
Texas Children’s Heart Center. He is also a
professor of Anesthesiology at Baylor College
of Medicine. Dr. Mossad’s training began as
an undergraduate at Cairo University, Egypt.
His medical degree is from University of
Cairo Medical School, and his residency and
fellowship training in cardiac anesthesia took
place at the Cleveland Clinic Foundation. He
completed a pediatric anesthesia fellowship
at Children’s National Medical Center of
George Washington University and an
echocardiography fellowship at the Cleveland
Clinic. Prior to joining Texas Children’s
Hospital in 2008, Dr. Mossad served as
section head for Congenital Cardiac
Anesthesia at the Cleveland Clinic from
1997-2008.
Dr. Mossad is actively involved in several
professional societies, including service on
committees for the Society of Cardiovascular
Anesthesiologists and Society for Pediatric
Anesthesia. He is also a founding board
member and currently serves as president
of the Congenital Cardiac Anesthesia
Society. Additionally, Dr. Mossad has 38
peer-reviewed publications and eight book
chapters, mostly in his field of interest of
coagulation management and perioperative
care of children and adults with congenital
heart disease. He also has a strong interest
in the training and education of fellows and
residents in the disciplines of pediatric and
cardiac anesthesia.
Lara S. Shekerdemian, M.D.,
F.R.A.C.P., M.H.A., is chief of Critical
Care at Texas Children’s Hospital and
co-director of Texas Children’s Heart
Center. She also serves as the vice chair
of Clinical Affairs for the Department of
Pediatrics and professor of Pediatrics at
Baylor College of Medicine. She graduated
from Birmingham University Medical School
and was awarded a postgraduate doctoral
degree for her thesis, “Cardiopulmonary
Interactions in Congenital Heart Disease,”
from the University of Birmingham. Dr.
Shekerdemian trained in pediatrics and
pediatric cardiology and undertook
postgraduate research in London. She
trained in critical care in London and
Toronto. She was previously on faculty
at the Great Ormond Street Hospital in
London and was most recently the chief
of Critical Care at The Royal Children’s
Hospital in Melbourne. Her research and
clinical interests include extracorporeal life
support, brain injury in infants and children
with heart disease, and outcomes in children
after admission to the intensive care unit.
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Texas Children’s Heart Center Medical Staff
To view online profiles for each of our physicians, visit texaschildrens.org/heart.
Congenital Heart Surgery
Charles D. Fraser, Jr., M.D., Chief
Iki Adachi, M.D.
Jeffrey S. Heinle, M.D.
Lauren Kane, M.D.
E. Dean McKenzie, M.D.
Carlos Mery, M.D.
Pediatric Cardiology
Daniel J. Penny, M.D., Ph.D., M.H.A., Chief
Hugh Allen, M.D., Ph.D.
Carolyn A. Altman, M.D., F.A.C.C., F.A.S.E.
Rachel Arnold, P.A.-C.
Nancy A. Ayres, M.D., F.A.C.C., F.A.S.E.
Manish Bansal, M.D.
Judith A. Becker, M.D.
Tasha Bryant, M.S.N., R.N., F.N.P.-C.,
C.P.N.P.-A.C.
Antonio G. Cabrera, M.D.
Allison Callender, P.A.-C.
Leigh Carreon, M.S.N., R.N., C.P.N.P.-A.C.
Constance Cephus, Ph.D., R.N.,
C.P.N.P.-A.C./P.C.
Kwonsoo Chun, M.D.
Cristina Clawson, M.S.N., R.N., C.P.N.P.-A.C.
Lisa D’Alessandro, M.D.
Caridad De La Uz, M.D.
Susan W. Denfield, M.D.
Heather A. Dickerson, M.D.
William J. Dreyer, M.D., F.A.C.C., F.A.A.P.
Peter Ermis, M.D.
Yuxin Fan, M.D.
Wayne J. Franklin, M.D.
Angela Gooden, M.S.N., R.N., C.P.N.P.-A.C./P.C.
Mary Hoang, M.S.N., R.N., C.P.N.P.-A.C./P.C.
Ben Jacob, P.A.-C.
Aamir Jeewa, M.D.
Henri Justino, M.D., C.M., F.R.C.P.C., F.A.C.C.,
F.S.C.A.I.
Josh A. Kailin, M.D.
Asra Khan, M.D.
Jeffrey J. Kim, M.D.
Michele Krenek, M.S.N., R.N., F.N.P.-C.
Julie K. Kuzin, M.S.N., R.N., C.P.N.P.-A.C./P.C.
William Buck Kyle, M.D.
Wilson Lam, M.D.
Renna Lange, M.S.N., R.N., C.P.N.P.-A.C.
M. Regina Lantin-Hermoso, M.D.
Emily J. Lawrence, D.O.
Katherine Lindle, M.D.
Aimee Liou, M.D.
Keila N. Lopez, M.D., M.P.H.
Shiraz A. Maskatia, M.D.
Wanda C. Miller-Hance, M.D.
Christina Miyake, M.D.
Silvana M. Molossi, M.D., Ph.D.
Douglas S. Moodie, M.D., M.S.
Shaine A. Morris, M.D., M.P.H.
Taylor Morse, M.S.N., R.N., C.P.N.P.-A.C.
Antonio R. Mott, M.D.
Michael R. Nihill, M.D.
Cory V. Noel, M.D.
Richard E. O’Brien, P.A.-C.
Elena C. Ocampo, M.D., F.A.A.P., F.A.C.C.
Dhaval R. Parekh, M.D.
Ricardo H. Pignatelli, M.D.
Jack Price, M.D.
Athar M. Qureshi, M.D.
Priscila P. Reid, M.S.N., R.N., F.N.P.-C.,
C.P.N.P.-A.C.
Alan F. Riley, M.D.
Shannon M. Rivenes, M.D.
Craig Rusin, M.D.
Alexia B. Santos, M.D.
Amy Sanyahumbi, M.D.
Tobias Schlingmann, M.D.
David W. Sapire, M.D.
Andrea Sawyer-Gray, M.S.N., R.N., C.P.N.P.-A.C.
Thomas J. Seery, M.D.
S. Kristen Sexson Tejtel, M.D., Ph.D.
America Suh, M.S.N., A.P.R.N., F.N.P.-C.
Santiago O.Valdes, M.D.
Thomas A.Vargo, M.D.
Giles W.Vick III, M.D., Ph.D.
Steven B. Wolfe, M.D.
Betul Yilmaz, M.D.
Justin Zachariah, M.D., M.P.H.
Cardiovascular Anesthesia
Emad B. Mossad, M.D., Director
Dean B. Andropoulos, M.D.
Tamra Baker, C.R.N.A.
Beth Barraza, R.N., C.P.N.P.
Kenneth M. Brady, M.D.
Lisa A. Caplan, M.D.
Barbi DeMoss, R.N., C.P.N.P.
R. Blaine Easley, M.D.
Jennifer Esplana, C.R.N.A.
H E A RT C E N T E R 2 0 1 5
Erin A. Gottlieb, M.D.
Stuart R. Hall, M.D.
Rhonda Martone, C.R.N.A.
Wanda C. Miller-Hance, M.D.
Princy Mohan, R.N., C.P.N.P.
Pablo Motta, M.D.
Laura Oates, C.R.N.A.
Elyse Parchmont, C.R.N.A.
Zoel Quinonez, M.D.
Ashraf Resheidat, M.D.
Premal Trivedi, M.D.
David F.Vener, M.D.
Lauren Weaver, C.R.N.A.
Saeed Yacouby, C.R.N.A.
Jennifer Yborra, R.N., P.N.P.-A.C.
Jordana Goldman, M.D.
Parag Jain, M.D.
Javier Lasa, M.D.
Jack F. Price, M.D.
Ashraf Resheidat, M.D.
Dantin J. Roddy, M.D.
Sebastian Tume, M.D.
Eric A. Williams, M.D., M.S., M.M.M., F.A.A.P.
Instructors in Pediatric Cardiac Critical Care
Charlie Bergstrom, M.D.
Mohammad Ebraheem, M.D.
Rhiannon Hickok, M.D.
Mary K. Olive, M.D.
Developmental Outcomes
Cardiac Critical Care
Lara S. Shekerdemian, M.D., F.R.A.C.P.,
M.H.A., Chief
Paul A. Checchia, M.D., F.A.A.P., F.C.C.M.,
F.A.C.C., Medical Director
Barbara-Jo Achuff, M.D.
Natasha Afonso, M.D.
Marc Anders, M.D.
Patricia Bastero, M.D.
Aarti Bavare, M.D., M.P.H.
Kenneth Brady, M.D.
Ronald A. Bronicki, M.D.
Antonio G. Cabrera, M.D.
Heather Chandler, M.D.
Heather A. Dickerson, M.D.
Ronald B. Easley, M.D.
Lara S. Shekerdemian, M.D., F.R.A.C.P., M.H.A.,
Medical Director
Eboni Smith, M.D., Clinic Lead
Sonia Monteiro, M.D.
Lisa Noll, Ph.D.
Daniel J. Penny, M.D., Ph.D., M.H.A.
Estrella Mazarico de Thomas, R.N.,
Outcomes Clinic Coordinator
Margaret Whitehead, R.N.,
Outcomes Research Coordinator
Quality
Eric A. Williams, M.D., M.S., M.M.M., F.A.A.P.,
Medical Director
Kathleen E. Carberry, R.N., M.P.H.,
Director, Outcomes & Impact Service
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Texas Children’s Heart Center Publications
Abd Ellah N, Taylor L, Troja W, Owens K, Ayres N, Pauletti G, Jones H. Development of non-viral,
trophoblast-specific gene delivery for placental therapy. PloS one. 2015;10:e0140879.
Achuff BJ, Nicolson SC, Elci OU, Zuppa AF. Intraoperative dexmedetomidine reduces postoperative
mechanical ventilation in infants after open heart surgery. Pediatr Crit Care Med. 2015 Jun;16(5):440-7.
Acosta S, Penny DJ, Rusin CG. An effective model of blood flow in capillary beds. Microvasc Res.
2015;100:40-47.
Acosta S, Puelz C, Riviere B, Penny DJ, Rusin CG. Numerical method of characteristics for
one-dimensional blood flow. J Comput Phys. 2015;294:96-109.
Adachi I, Burki S, Zafar F, Morales DL. Pediatric ventricular assist devices. J Thorac Dis. 2015;7(12):
2194-2202.
Adachi I, Guzman-Pruneda FA, Jeewa A, Fraser CD Jr., McKenzie DE. A modified implantation technique
of the Heartware ventricular assist device for pediatric patients. J Heart Lung Transplant. 2015;34:134-136.
Adachi I, Guzman-Pruneda FA, Khan MS, McKenzie ED, Fraser CD Jr. Ventricular assist device in children
with cardiac graft failure. ASAIO J. 2015;61:729-730.
Adachi I, Khan MS, Guzman-Pruneda FA, Fraser CD 3rd, Mery CM, Denfield SW, Dreyer WJ, Morales
DL, McKenzie ED, Heinle JS, Fraser CD Jr. Evolution and impact of ventricular assist device program on
children awaiting heart transplantation. Ann Thorac Surg. 2015;99:635-640.
Adachi I, Shekerdemian L, Checchia PA, Fraser CD Jr. Treatment of Heart Failure: Mechanical Support.
In: Rogers’ Textbook of Pediatric Intensive Care. Nichols D, Shaffner H, 5th edition. Lippincott Williams &
Wilkins, Philadelphia, PA. 2015.
Akcan Arikan A, Williams EA, Graf JM, Kennedy CE, Patel B, Cruz AT. Resuscitation bundle in pediatric
shock decreases acute kidney injury and improves outcomes. J Pediatr. 2015;167:1301-5.
Akinkuotu AC, Sheikh F, Olutoye OO, Lee TC, Fernandes CJ, Welty SE, Ayres NA, Cass DL. Giant
omphaloceles: Surgical management and perinatal outcomes. J Surg Res. 2015;198:388-392.
Altman CA. Appropriate use criteria: Vital new link in the chain of quality in pediatric echocardiography.
J Am Coll Cardiol. 2015;66:1141-1143.
Altman CA, Barker P. Highlights of the 26(th) scientific sessions’ pediatric congenital track.
J Am Soc Echocardiogr. 2015;28:25A.
Anderson R, Moodie DS, McLaughlin ES. Interview with Roberts Anderson. Congenit Heart Dis.
2015;10:96-104.
Asaki SY, McKenzie ED, Elias B, Adachi I. Rectus-sparing technique for driveline insertion of ventricular
assist device. Ann Thorac Surg. 2015;100:1920-1922.
Axelrod DM, Alten JA, Berger JT, Hall MW, Thiagarajan R, Bronicki RA. Immunologic and infectious
diseases in pediatric cardiac critical care: Proceedings of the 10th International Pediatric Cardiac Intensive
Care Society Conference. World J Pediatr Congenit Heart Surg. 2015 Oct;6(4):575-87.
Bainbridge MN, Davis EE, Choi WY, Dickson A, Martinez HR, Wang M, Dinh H, Muzny DM, Pignatelli R,
Katsanis N, Boerwinkle E, Gibbs RA, Jefferies JL. Loss of function mutations in NNT are associated with
left ventricular noncompaction. Circ Cardiovasc Genet. 2015;8:544-552.
Baker EH, Altman CE. Maternal ratings of child health and child obesity, variations by mother’s race/
ethnicity and nativity. Matern Child Health J. 2015;19:1000-1009.
Banka P, Robinson JD, Uppu SC, Harris MA, Hasbani K, Lai WW, Richmond ME, Fratz S, Jain S, Johnson
TR, Maskatia SA, Lu JC, Samyn MM, Patton D, Powell AJ. Cardiovascular magnetic resonance techniques
and findings in children with myocarditis: A multicenter retrospective study. J Cardiovasc Magn Reson.
2015;17:96.
Barton AL, Moffett BS, Valdes SO, Miyake C, Kim JJ. Efficacy and safety of high-dose propranolol for the
management of infant supraventricular tachyarrhythmias. J Pediatr. 2015;166:115-118.
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Bastero P, DiNardo JA, Pratap JN, Schwartz JM, Sivarajan VB. Early perioperative management after
pediatric cardiac surgery: Review at PCICS 2014. World J Pediatr Congenit Heart Surg. 2015 Oct;6(4):565-74.
Beaty RS, Moffett BS, Hall S, Kim J. Evaluating the safety of intraoperative antiarrhythmics in pediatric
cardiac surgery patients. Pediatr Cardiol. 2015;36(7):1465-1469.
Beg K, Latson LA, Pettersson G, Wallace L, Qureshi AM. Aorta-to-left atrial fistula developing after
surgical removal of an atrial septal occlusion device eight years after original implantation. World J Pediatr
Congenit Heart Surg. 2015;6:320-323.
Bolin EH, Maskatia SA, Tate AL, Petit CJ. Older age at completion of fontan procedure is associated with
improved percentage of predicted maximum oxygen uptake. Tex Heart Inst J. 2015;42:333-340.
Brady K, Andropoulos DB, Kibler K, Easley RB. A new monitor of pressure autoregulation: What does it
add? Anesth Analg. 2015;121(5):1121-3.
Bronicki RA. Cardiopulmonary interactions in children with heart failure. Curr Cardiol Rev. 2015 Nov 19.
Bronicki RA, Anas NG. The right therapy at the right time in the right patient. Pediatr Crit Care Med. 2015
May;16(4):389-90.
Bronicki RA, Fortenberry J, Schreiber M, Potenziano J, Stauffer J, Young J, Checchia PA, Anas NG.
Multicenter randomized controlled trial of inhaled nitric oxide for pediatric acute respiratory distress
syndrome. J Pediatr. 2015 Feb;166(2):365-369.
Cabrera AG, Chen DW, Pignatelli RH, Khan MS, Jeewa A, Mery CM, McKenzie ED, Fraser CD Jr.
Outcomes of anomalous left coronary artery from pulmonary artery repair: Beyond normal function. Ann
Thorac Surg. 2015 Apr;99(4):1342-7. doi: 10.1016/j.athoracsur.2014.12.035. Epub 2015 Feb 26.
Caplan L. S11. Pain is in the eye of the beholder. J Anesth Hist. 2015;1(3):91-2.
Cephus CE, Qureshi AM, Sexson-Tejtel SK, Goss JA, Moodie DS. Liver transplantation for HoFH in
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Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia
PA, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Raj SS, Gertz S, Howard K, Harmon
K, Lahni P, Frank E, Hart KW, Lindsell CJ. Prospective testing and redesign of a temporal biomarker based
risk model for patients with septic shock: Implications for septic shock biology. EBioMedicine. 2015 Nov
22;2(12):2087-93.
H E A RT C E N T E R 2 0 1 5
Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia
PA, Meyer K, Shanley TP, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Shekhar RS, Gertz S,
Dawson E, Howard K, Harmon K, Lahni P, Frank E, Hart KW, Lindsell CJ. A multi-biomarker-based risk
model for estimating the risk of septic acute kidney injury. Crit Care Med. 2015 Aug;43(8):1646-53.
Yang PC, Moreno JD, Miyake CY, Vaughn-Behrens SB, Jeng MT, Grandi E, Wehrens XH, Noskov S, Clancy
CE. In silico prediction of drug therapy in catecholaminergic polymorphic ventricular tachycardia. J Physiol.
2015.
Yang X, Wang T, Lin X, Yue X, Wang Q, Wang G, Fu Q, Ai X, Chiang DY, Miyake CY, Wehrens XH,
Chang J. Genetic deletion of rnd3/rhoe results in mouse heart calcium leakage through upregulation of
protein kinase A signaling. Circ Res. 2015;116:e1-e10.
Zachariah JP, Hwang S, Hamburg NM, Benjamin EJ, Larson MG, Levy D, Vita JA, Sullivan LM, Mitchell GF,
Vasan RS. Circulating adipokines and vascular function: Cross-sectional associations in a community-based
cohort. Hypertension. 2015.
Zachariah JP, McNeal CJ, Copeland LA, Fang-Hollingsworth Y, Stock EM, Sun F, Song JJ, Gregory ST,
Tom JO, Wright EA, VanWormer JJ, Cassidy-Bushrow AE. Temporal trends in lipid screening and therapy
among youth from 2002 to 2012. J Clin Lipidol. 2015;9:S77-87.
Zachariah JP, Samnaliev M. Echo-based screening of rheumatic heart disease in children:
A cost-effectiveness Markov model. J Med Econ. 2015;18:410-419.
Zafar F, Jefferies JL, Tjossem CJ, Bryant R 3rd, Jaquiss RD, Wearden PD, Rosenthal DN, Cabrera AG,
Rossano JW, Humpl T, Morales DL. Biventricular Berlin Heart EXCOR pediatric use across the United
States. Ann Thorac Surg. 2015;99:1328-1334.
57
56
H E A RT C E N T E R 2 0 1 4
Texas Children’s Heart Center Referrals
To refer your pediatric patient to Texas Children’s Heart Center, please call 832-82-HEART
(832-824-3278).
Congenital Heart Surgery
The Congenital Heart Surgery service at Texas Children’s Hospital offers same-day surgical
consultation appointments. To make an appointment for a same-day consultation, call
832-TCH-APPT (832-824-2778). For additional appointment information or to speak
with a division administrator, please call 832-826-2030.
Cardiology, Adult Congenital Heart Disease and the Cardiovascular
Intensive Care Unit
832-82-HEART (832-824-3278)
Heart Transplant Program
866-683-8032
Cardiovascular Anesthesia
832-826-5831
Referrals
Visit texaschildrens.org/refer for more information about referring a patient, or learn more
aboutCongenital
Texas Children’s
Heart
Center at texaschildrens.org/heart.
Heart
Surgery
The Congenital Heart Surgery Service at Texas Children’s Hospital offers same-day surgical
consultation appointments. To make an appointment for a same-day consultation, call
832-TCH-APPT (832-824-2778). For additional appointment information or to speak
with a division administrator, please call 832-826-2030.
Heart Transplant Program
866-683-8032
Cardiology, Adult Congenital Heart Disease and Cardiovascular Intensive Care Unit
832-82-HEART (832-824-3278)
Cardiovascular Anesthesia
832-826-5831
To refer a patient to Texas Children’s Heart Center,
please call 832-82-HEART (832-824-3278).
With six decades of experience in caring for children’s hearts, Texas
Children’s Heart Center combines leading, world-class technology with
a compassionate, family-centered approach to pediatric cardiac care.
Our multidisciplinary team of pediatric cardiologists, cardiovascular
surgeons, cardiovascular anesthesiologists, perfusionists, adult congenital
heart disease specialists, cardiac intensivists, nurses, child life specialists
and support staff work together to surround patients with expertise at
every point from diagnosis through treatment in order to provide the best
possible results.
Meet the Texas Children’s Heart Center team.
(FLIP OPEN)
Visit texaschildrens.org/refer for more information about referring a patient or learn more
about Texas Children’s Heart Center at texaschildrens.org/heart.
H E A RT C E N T E R 2 0 1 5
Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, Weiss SL, Fitzgerald J, Checchia
PA, Meyer K, Shanley TP, Quasney M, Hall M, Gedeit R, Freishtat RJ, Nowak J, Shekhar RS, Gertz S,
Dawson E, Howard K, Harmon K, Lahni P, Frank E, Hart KW, Lindsell CJ. A multi-biomarker-based risk
model for estimating the risk of septic acute kidney injury. Crit Care Med. 2015 Aug;43(8):1646-53.
Yang PC, Moreno JD, Miyake CY, Vaughn-Behrens SB, Jeng MT, Grandi E, Wehrens XH, Noskov S, Clancy
CE. In silico prediction of drug therapy in catecholaminergic polymorphic ventricular tachycardia. J Physiol.
2015.
Yang X, Wang T, Lin X, Yue X, Wang Q, Wang G, Fu Q, Ai X, Chiang DY, Miyake CY, Wehrens XH,
Chang J. Genetic deletion of rnd3/rhoe results in mouse heart calcium leakage through upregulation of
protein kinase A signaling. Circ Res. 2015;116:e1-e10.
Zachariah JP, Hwang S, Hamburg NM, Benjamin EJ, Larson MG, Levy D, Vita JA, Sullivan LM, Mitchell GF,
Vasan RS. Circulating adipokines and vascular function: Cross-sectional associations in a community-based
cohort. Hypertension. 2015.
Zachariah JP, McNeal CJ, Copeland LA, Fang-Hollingsworth Y, Stock EM, Sun F, Song JJ, Gregory ST,
Tom JO, Wright EA, VanWormer JJ, Cassidy-Bushrow AE. Temporal trends in lipid screening and therapy
among youth from 2002 to 2012. J Clin Lipidol. 2015;9:S77-87.
Zachariah JP, Samnaliev M. Echo-based screening of rheumatic heart disease in children:
A cost-effectiveness Markov model. J Med Econ. 2015;18:410-419.
Zafar F, Jefferies JL, Tjossem CJ, Bryant R 3rd, Jaquiss RD, Wearden PD, Rosenthal DN, Cabrera AG,
Rossano JW, Humpl T, Morales DL. Biventricular Berlin Heart EXCOR pediatric use across the United
States. Ann Thorac Surg. 2015;99:1328-1334.
57
56
H E A RT C E N T E R 2 0 1 4
Texas Children’s Heart Center Referrals
To refer your pediatric patient to Texas Children’s Heart Center, please call 832-82-HEART
(832-824-3278).
Congenital Heart Surgery
The Congenital Heart Surgery service at Texas Children’s Hospital offers same-day surgical
consultation appointments. To make an appointment for a same-day consultation, call
832-TCH-APPT (832-824-2778). For additional appointment information or to speak
with a division administrator, please call 832-826-2030.
Cardiology, Adult Congenital Heart Disease and the Cardiovascular
Intensive Care Unit
832-82-HEART (832-824-3278)
Heart Transplant Program
866-683-8032
Cardiovascular Anesthesia
832-826-5831
Referrals
Visit texaschildrens.org/refer for more information about referring a patient, or learn more
aboutCongenital
Texas Children’s
Heart
Center at texaschildrens.org/heart.
Heart
Surgery
The Congenital Heart Surgery Service at Texas Children’s Hospital offers same-day surgical
consultation appointments. To make an appointment for a same-day consultation, call
832-TCH-APPT (832-824-2778). For additional appointment information or to speak
with a division administrator, please call 832-826-2030.
Heart Transplant Program
866-683-8032
Cardiology, Adult Congenital Heart Disease and Cardiovascular Intensive Care Unit
832-82-HEART (832-824-3278)
Cardiovascular Anesthesia
832-826-5831
To refer a patient to Texas Children’s Heart Center,
please call 832-82-HEART (832-824-3278).
With six decades of experience in caring for children’s hearts, Texas
Children’s Heart Center combines leading, world-class technology with
a compassionate, family-centered approach to pediatric cardiac care.
Our multidisciplinary team of pediatric cardiologists, cardiovascular
surgeons, cardiovascular anesthesiologists, perfusionists, adult congenital
heart disease specialists, cardiac intensivists, nurses, child life specialists
and support staff work together to surround patients with expertise at
every point from diagnosis through treatment in order to provide the best
possible results.
Meet the Texas Children’s Heart Center team.
(FLIP OPEN)
Visit texaschildrens.org/refer for more information about referring a patient or learn more
about Texas Children’s Heart Center at texaschildrens.org/heart.
Texas Children’s Heart Center
2015
Texas Children’s Heart Center
6621 Fannin Street
Houston, Texas 77030
texaschildrens.org/heartoutcomes
texaschildrens.org/refer
©2016 Texas Children’s Hospital. All Rights Reserved. Heart233 060916