Rebecca Kameny

All Publications

• Racial and Ethnic Disparities in Cardiac Reintervention after Pediatric Cardiac Surgery. The Annals of thoracic surgery Saha, P., Tjoeng, Y. L., Algaze, C., Kameny, R., Pinto, N., Chan, T. 2023

  Abstract

  BACKGROUND: Children undergoing cardiac surgery may require postoperative surgical or catheter-based reintervention prior to discharge. We examined racial/ethnic variations in reintervention and associated in-hospital mortality.METHODS: Children undergoing cardiac surgery from 2004 to 2015 were identified in the Pediatric Health Information Systems (PHIS) database. Regression analysis measured associations between race/ethnicity, in-hospital mortality, and postoperative cardiac surgical or catheter-based reintervention (Surgery/Catheter Reintervention).RESULTS: Of 124,263 patients, 8,265 (6.7%) had a Surgery/Catheter Reintervention. Black patients had fewer reinterventions (5.9% versus 6.7%) and higher in-hospital mortality (3.9% versus 2.7%, p<0.01) than White patients. After adjusting for sociodemographic and illness severity indicators, Black patients remained less likely to receive Surgery/Catheter Reintervention (adjusted Hazard Ratio [aHR] 0.89, 95% confidence interval [CI] 0.82-0.98) despite having similar risk of death after reintervention (adjusted Odds Ratio [aOR] 1.17, 95% CI 0.98-1.41) compared with White patients. Black and Other race/ethnicity patients also had higher risk of death without Surgery/Catheter Reintervention (aHR 1.26, 95% CI 1.08-1.47 and aHR 1.33, 95% CI 1.13-1.57, respectively) than White patients. Similar trends were demonstrated when mechanical circulatory support and cardiac transplantation were included as reinterventions.CONCLUSIONS: Patients of Black and Other race/ethnicity undergoing pediatric cardiac surgery are more likely to die without postoperative cardiac reintervention than White patients. Black patients are also less likely to receive reintervention despite no significant difference in mortality with reintervention. Further studies should evaluate etiologies and methods of addressing these disparities.

  View details for DOI 10.1016/j.athoracsur.2023.10.027

  View details for PubMedID 37923240

• Pulmonary Vasodilator Therapy in Pediatric Patients on Ventricular Assist Device Support: A Single-Center Experience and Proposal for Use. ASAIO journal (American Society for Artificial Internal Organs : 1992) Schramm, J. E., Dykes, J. C., Hopper, R. K., Feinstein, J. A., Rosenthal, D. N., Kameny, R. J. 2023

  Abstract

  Pediatric precapillary pulmonary hypertension can develop in response to systemic atrial hypertension. Systemic atrial decompression following ventricular assist device (VAD) implantation may not sufficiently lower pulmonary vascular resistance (PVR) to consider heart transplant candidacy. Prostacyclins have been used in adult VAD patients with success, but pediatric data on safety and efficacy in this population are limited. We sought to describe our center's experience to show its safety and to present our current protocol for perioperative use. We reviewed our use of prostacyclin therapy in pediatric patients on VAD support with high PVR from 2016 to 2021. Of the 17 patients who met inclusion, 12 survived to transplant and 1 is alive with VAD in situ. All patients survived posttransplant. With continuous intravenous (IV) epoprostenol or treprostinil therapy, there were no bleeding complications or worsening of end-organ function. A significant reduction was observed in vasoactive inotropic scores by 49% in the first 24 hours post-prostacyclin initiation. The proportion of patients surviving to transplant in this high-risk cohort is favorable. In conclusion, prostacyclins may be safe to use in patients with elevated PVR as part of their VAD and transplant course and may provide a transplant option in those otherwise not candidates.

  View details for DOI 10.1097/MAT.0000000000002023

  View details for PubMedID 37556563

• A case of acquired von Willebrand disease in severe pediatric pulmonary hypertension contributing to bleeding following reverse Potts shunt. Pulmonary Circulation Sullivan, R. T., Lo, C., Martin, E., Kameny, R. J., Hopper, R. K. 2022; 12 (e12042)

  View details for DOI 10.1002/pul2.12042

• A case of acquired von Willebrand disease in severe pediatric pulmonary hypertension contributing to bleeding following reverse Potts shunt. Pulmonary circulation Sullivan, R. T., Lo, C., Martin, E., Kameny, R. J., Hopper, R. K. 2022; 12 (1): e12042

  Abstract

  The reverse Potts shunt is increasingly used as a palliative measure for end-stage pulmonary arterial hypertension (PAH) as a means to offload the right ventricle and improve functional status. This case report describes a child who developed significant hemothorax after reverse Potts shunt that required surgical exploration, blood product administration, and prolonged intensive care hospitalization. Despite lack of preoperative bleeding symptoms, testing revealed acquired von Willebrand disease (aVWD), with subsequent resolution of bleeding. Alterations in von Willebrand factor, including aVWD, have been reported in children with severe PAH but have not previously been associated with bleeding after reverse Potts shunt procedure. As bleeding is a recognized postoperative morbidity in PAH patients undergoing reverse Potts shunt, we highlight a potential role for preoperative testing for aVWD as perioperative factor replacement therapy may improve postoperative outcomes.

  View details for DOI 10.1002/pul2.12042

  View details for PubMedID 35506098

  View details for PubMedCentralID PMC9052962