Browsing by Author "Ogunyankin, Fadeke"
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Item Aortic Coarctation Repair Outcomes Based on Surgical Approach and Age(2020) Burch, Phil; Hamby, Tyler; Ogunyankin, Fadeke; Kway, KristiBackground: Coarctation of the aorta, or narrowing of the aorta, accounts for 6-8% of all congenital heart defects. The two most common surgical techniques for repair of coarctation are coarctectomy with end-to-end anastomosis, performed via a lateral thoracotomy approach, and patch aortoplasty, performed via median sternotomy. The purpose of this study is to identify surgical variables that affect long-term outcomes of repair. Methods: This is a retrospective cohort study of patients under one year of age who underwent coarctation repair at Cook Children's Medical Center between January 1, 2014 and March 1, 2018. Exclusion criteria included patients who had complex coexisting cardiac malformations other than atrial septal defect (ASD) or ventricular septal defect (VSD). Using Fisher's Exact test, relationships were examined between type of surgery (lateral thoracotomy vs. medial sternotomy), age at surgery (0-30 vs. 31-365 days), and transverse aortic arch measurement (?-3 vs. >-3 z-score) with elevated blood pressure and incidence of recurrent coarctation. Results: There were 64 patients that met study criteria. We found that type of surgery, age at surgery, and transverse aortic arch measurement had no significant association (p > 0.05) with either blood pressure or recurrence of coarctation. Conclusion: The current data does not support an association between the studied variables and either systemic hypertension and recurrent coarctation. However, the sample size is limited which limits the statistical power of our current study. Increasing the length of time reviewed may identify clinically important relationships.Item Identifying Factors That May Affect Mortality of Infants with Hypoplastic Left Heart Syndrome(2019-03-05) Kuo, James; Hamby, Tyler; Ogunyankin, Fadeke; Li, Tommy1. Purpose/BackgroundHypoplastic left heart syndrome (HLHS) is a severe congenital heart defect that is fatal without surgical intervention. The CDC states that HLHS make up approximately 3% of all congenital heart defects and occur in about 3 babies per 10,000 live births. While studies have shown that survival rates are improving (5-10 year survival rate was 50-60% in 2001, 60-80% in 2014), there are still many factors that play a role in the outcome of patients born with HLHS that needs further investigation. This study aims to determine specific risk factors that may affect mortality in HLHS patients. 2. MethodsWe conducted a retrospective cohort study of patients with HLHS who underwent Norwood surgery at Cook Children’s Medical Center between January 1, 2007 and December 31, 2017. The variables included total length of intubation time (≥7 days vs.days), degree of atrial septal defect (restricted vs. intact), timing of HLHS diagnosis (prenatal vs. postnatal), and survival to initial discharge (alive vs. dead). These groups were compared using descriptive statistics and chi-square test of independence. A p-value 3. ResultsThere were 151 patients meeting study criteria and 124 (82.1%) survived to discharge. We found that patients who were intubated ≥7 days were less likely to survive to discharge (75.6% vs. 91.8%; p=0.01). RAS/IAS and timing of diagnosis was not significantly related to survival to initial discharge. 4. ConclusionThe results suggest intubation length may play a role in patient outcome and mortality, but we cannot state that there is a direct correlation from this study alone. Further analysis must be done in order to determine whether intubation length itself contributed to mortality or if confounding variables were responsible.Item Maternal Risk Factors Do Not Correlate With AKI in Patients With Congenital Heart Disease (CHD)(2024-03-21) Carl, Christopher; Najjar, Sam; Ogunyankin, Fadeke; Modem, Vinai; Lanier, LanePurpose: Acute kidney injury (AKI) is a common complication in children who undergo cardiopulmonary bypass (CPB) and is correlated with longer hospital courses and worse outcomes. Several risk factors exist which increase the risk of AKI in pediatric populations, including premature birth, congenital heart disease (CHD), and prolonged CPB time. Maternal risk factors can impair nephrogenesis in utero, thereby increasing the likelihood for developing AKI. However, it is yet to be shown if maternal risk factors lead to an increased incidence in AKI in pediatric patients with CHD who undergo CPB. We examine the incidence of four maternal risk factors—pre-eclampsia, maternal hypertension, gestational diabetes mellitus, and maternal smoking—in 252 pediatric CHD patients who underwent CPB surgery. The purpose of this project was to examine the incidence and predictors of AKI in pediatric patients who underwent cardiopulmonary bypass (CPB) surgery at our institution. We hypothesize an association between maternal risk factors and AKI incidence in pediatric patients with CHD who underwent CPB surgery. Methods: We performed a retrospective study on 252 patients who underwent CPB for repair of a CHD between March1, 2020, and March 1, 2022. Patients were between ages 0-12 months at time of surgery and received care in the cardiac intensive care unit (CICU). P-value of 0.05 was used to determine statistical significance. NGAL levels and Cystatin C levels were also obtained. Results: Forty-four patients (17.5%) developed AKI by KDIGO criteria, with only 2.4% of those meeting stage 2 or 3 AKI. Fifty-one (24%) patients demonstrated elevated urine NGAL levels after bypass (>125). Eighteen patients (8.4%) had elevated levels of Cystatin C. Pre-eclampsia was not protective in regards to AKI in our population. Maternal smoking, maternal gestational diabetes and maternal hypertension did not correlate with development of AKI in children with CHD undergoing CPB. Conclusion: We found no association between maternal risk factors and AKI incidence in CHD patients undergoing CPB surgery in this cohort. Elevated NGAL levels and Cystatin C levels following CPB did not individually correlate with increased odds of developing AKI.Item Preoperative factors affecting mortality in HLHS patients undergoing the Norwood procedure(2020) Ogunyankin, Fadeke; Hamby, Tyler; Kuo, James; Karnkowska, BarbaraHypoplastic left heart syndrome (HLHS) is characterized by hypoplasia of the left heart and outflow tract. The three-stage surgical reconstruction of heart consists of circumventing the underdeveloped left ventricle by connecting right ventricle to systemic circulation and grafting a passive flow conduit which shunts venous blood into pulmonary artery. First stage surgery (Norwood) has the highest mortality among common congenital surgeries (7-19%) followed by a high risk interstage (IS) phase where additional 4-15% of infants die. A retrospective chart review of HLHS patients was conducted at Cook Children's hospital between January 2007 and January 2017. Objective of the study was to identify preoperative risk factors that may lead to premature death during IS. Univariate logistic regression analyses were used to determine whether feeding, intubation, and extracorporeal membrane oxygenation (ECMO) predicted mortality. IS was defined as time following Norwood procedure until Glenn, the second stage of reconstruction. Analysis revealed that receiving Norwood feeding prior to surgery was associated with lower mortality (OR=0.42, CI=0.20-0.90, p= 0.025). Furthermore, intubation prior to surgery (OR=1.73, CI=1.05-2.85, p= 0.03) and pre-operative ECMO (OR=2.83, CI=1.12-7.19, p=0.028) were associated with higher IS mortality. Current findings suggest a positive relationship between pre-operative respiratory interventions and increased rate of post-operative mortality. This relationship suggests that pulmonary status and inability to feed may be the leading prognostic factors in IS infant death. Norwood nutrition and continued respiratory support warrant further studies in order to understand the clinical implications of these findings.Item SecurAcath Device Safety and Efficacy in Pleural Tube Placement in Children(2024-03-21) Patrick, Kara; Lanier, Lane; Debs, Fouad; Ogunyankin, Fadeke; Duncan, JayBackground: Patients in the cardiac intensive care unit (CICU) may develop complications such as pneumothorax (PTX) or pleural effusion (PE), which may be bloody, chylous, or serous in composition. PTX or PE may require placement of a percutaneous chest tube (CT) to evacuate air or fluid in the pleural space. Historically, CTs are sutured to the skin, but migration and removal of CTs can occur inadvertently due to external factors. The securAcath device is a single-use securement device indicated for securement of percutaneous indwelling catheters/tubes and is in use at the Cook Children’s Medical Center (CCMC) CICU. In this study, we introduce a novel use for this securAcath device in CT securement and aim to determine the effectiveness of the securAcath device in CT securement by assessing the incidence in catheter/tube dislodgement and migration. We compared the efficacy of securAcath device to the typical suturing practice for patients admitted to the CICU at CCMC. Case Information: This is a retrospective cohort of patients undergoing CT placement while admitted to the CCMC CICU from March 1, 2018 to March 31, 2023. Patients under 18 years of age using the securAcath device or suture in CT placement while on admission were included. Initial screening for patient encounters yielded 176 subjects. 140 patients met inclusion/exclusion criteria with 204 CT insertions. The data collected included diagnosis prior to chest tube insertion, chromosome abnormalities, type of congenital heart disease, surgical history, chest tube insertions, date of insertion and removal, SecurAcath or suture usage, complications, inadvertent removal, infection, and bleeding. Differences in duration of CT insertion between the securAcath device group and suture group were analyzed by independent sample t-test for continuous data. Chi square test of independence was used to evaluate the association between dependent and independent variables. All statistical tests were two-sided. P-value of less than 0.05 was utilized as a cutoff for statistical significance. Information: Two hundred and four 8.5 French chest tubes were inserted by intensivists in the CICU on 140 patients. There was no statistical difference in gender, diagnosis or type of congenital heart disease between the securAcath device group and suture group. There was no significance in the number of CTs inserted or the duration of the CTs between groups. No significance was found between groups with infection at the CT site or bleeding complications. The securAcath device group was noted to have a lower incidence of inadvertent removal of the CT compared to the suture group. Conclusions: The securAcath device is as safe as suture securement in children in the CICU who require CT insertion. The securAcath device demonstrates a lower incidence of inadvertent removal compared to suture securement of CTs in children in the CICU.