HEART CENTER OUTCOMES 2018 - Texas Children's Hospital
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H E A RT C E N T E R O U TC O M E S 2 018TABLE OF CONTENTSABOUT US2TEXAS CHILDREN’S HEART CENTER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4LESTER AND SUE SMITH LEGACY TOWER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4TEXAS CHILDREN’S HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6PROGRAMS8ADULT CONGENITAL HEART DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11CARDIAC DEVELOPMENTAL OUTCOMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13CARDIAC IMAGING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14CARDIAC INTENSIVE CARE UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17CARDIOLOGY TRANSITION MEDICINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20CARDIOVASCULAR ANESTHESIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21CONGENITAL HEART SURGERY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28CORONARY ARTERY ANOMALIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33ELECTROPHYSIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34FETAL CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37HEART FAILURE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39HEART TRANSPLANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41INTERVENTIONAL CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42PREVENTIVE CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44SINGLE VENTRICLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45CONTACT US46OUTCOMES & IMPACT SERVICE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48REFERRALS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48To access Texas Children’s Heart Center outcomes information online, please visit texaschildrens.org/heartoutcomes.1
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4H E A RT C E N T E R O U TC O M E S 2 018TEXAS CHILDREN’S HEART CENTER Texas Children’s Hospital has been a leader in pediatric heart care formore than 60 years. Led by Denton Cooley, M.D., and Dan McNamara,M.D., the hospital started performing heart surgery on children in 1956.Dr. McNamara, a patriarch of pediatric cardiology, and Dr. Cooley, a pioneerheart surgeon, were among the first to demonstrate that small children couldsafely undergo heart surgery.Today, Texas Children’s Heart Center is a global leader in pediatric cardiaccare, treating some of the rarest and most complex heart cases. Withseveral multidisciplinary teams working in conjunction with pediatricsubspecialists throughout the hospital, the Heart Center strives to provideunparalleled care at every point from diagnosis through treatment andfollow-up, in order to achieve the best possible result for each patient.For the third consecutive year, Texas Children’s Hospital is ranked as the #1place in the nation for children to receive cardiology and heart surgery careby U.S. News & World Report in their 2019-20 edition of Best Children’s Hospitals. Texas Children’s Heart Center is committedto consistently achieving outcomes that are among the best in the country.HEART CENTER MOVES TO NEWLESTER AND SUE SMITH LEGACY TOWERTexas Children’s Heart Center had a monumental year in 2018 with the move into the new state-of-the-art Lester and SueSmith Legacy Tower. The milestone came just months after the historic May 22 move of our pediatric intensive care andprogressive care units into the spacious, high-tech tower.The MoveOver the course of about eight hours on Sept. 25, six specially trained clinical teams comprised of more than 200 memberstransported 64 heart patients, some critically ill, safely to their new, state-of-the-art rooms in the tower. The patients ranged inage from 3 days to 22 years.The following day, an 11-year-old patient became the first patient to undergo a cardiac catheterization procedure and anintra-cath MRI in the Heart Center’s new Charles E. Mullins, M.D. Cardiac Catheterization Laboratories.On Sept. 27, the Heart Center’s new cardiovascular operating rooms were officially opened, ushering in a new era of cardiacsurgery at Texas Children’s. Later that morning, a 4-year-old patient underwent the first surgical intervention in the expansivenew space – a Fontan procedure.And on Oct. 1, patients received treatment for the first time in the tower’s new therapy gym. The gym is a powerful resourceto help children and parents learn and focus on what they can do, rather than what they can’t. Features include machines forbuilding core strength and balance, exercise bikes and a bathtub and set of stairs for parents to practice everyday tasks athome with their children.A week before the move, patients and families entered the doors of the Heart Center’s new outpatient clinic for the firsttime. Situated on the 21st and 22nd floors of the tower, the clinic is designed top to bottom with Texas Children’s familiesin mind. The bright, welcoming space was specially configured to offer a more personal approach to care, and to handlehigh clinical volume.
H E A RT C E N T E R O U TC O M E S 2 018The PurposeTexas Children’s started planning for the Lester and Sue Smith Legacy Tower more than five years ago in an effort to reinvestin the needs of our most critically ill patients. Demand for the level of care Texas Children’s Hospital privides continuesto grow – here in our community and far beyond Houston. And prior to this expansion, our core areas – Critical Care,Emergency Center, ORs and PACU – were often at capacity.As an organization, we saw an opportunity to advance quality, service, safety and strategic growth; broaden our expertise;better coordinate care to improve the patient/family experience; and expand access to make certain we do not have to turnchildren away when they need us most.The tower is helping Texas Children’s accomplish all of this and more in the 640,000-square-foot space that includes: Eight floors for Texas Children’s Heart CenterSeven floors of intensive care patient roomsOne radiology suiteSix high-intensity surgical operating roomsFour cardiovascular operating roomsTwo intraprocedural MRIsFour cardiac catheterization labsOne helistopTo learn more, visit legacytower.org.5
6H E A RT C E N T E R O U TC O M E S 2 018 TEXAS CHILDREN’S HOSPITALTexas Children’s Hospital isaffiliated with Baylor Collegeof Medicine in the areas ofpediatrics, pediatric surgeryand obstetrics and gynecology.Baylor is ranked by U.S. News& World Report as one of thenation’s top 10 medical schoolsfor pediatrics. Currently andthroughout our partnership,Texas Children’s Hospital servesas Baylor’s primary pediatrictraining site. The collaborationbetween Texas Children’sHospital and Baylor is one ofthe top five such partnershipsfor pediatric research fundingfrom the National Institutesof Health.Physicians are employees ofBaylor College of Medicine,not Texas Children’s Hospital.Because they practice at TexasChildren’s Hospital, they maybe referred to as “our team” or“Texas Children’s physicians”throughout this report.Affiliated withTexas Children’s Hospital is one of the nation’s largest and mostcomprehensive specialty pediatric hospitals, with 4.3 million patient encountersin 2018. With a staff of more than 13,500 employees and 2,000 physicians,pediatric subspecialists, pediatric surgical subspecialists and dentists, TexasChildren’s offers more than 40 subspecialties, programs and services.The 2019-20 edition of Best Children’s Hospitals by U.S. News & World Reportranked Texas Children’s Hospital third in the country among nearly 200pediatric centers. For the eleventh straight year, Texas Children’s Hospital wasplaced on the Best Children’s Hospital Honor Roll of best pediatric institutions,one of only 10 hospitals nationally and the only hospital in Texas awardedthis distinction.Texas Children’s Hospital is located near downtown Houston in the TexasMedical Center, the largest medical center in the world. This campus includesnearly 800 licensed beds; the Mark A. Wallace Tower for outpatient visits; theFeigin Tower for pediatric research; Texas Children’s Pavilion for Women,a comprehensive OB/GYN facility with a focus on high-risk births; and theTexas Children’s Hospital Jan and Dan Duncan Neurological ResearchInstitute , a basic research institute dedicated to solving childhood neurologicaldiseases. Additionally, two community hospitals, Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands, bring specialtypediatric care – including an additional 160 licensed acute care and critical carebeds, two 24/7 pediatric emergency centers, full-service surgical suites andmore than 20 subspecialty clinics a piece – to a rapidly expanding population ofchildren across the west and north of Houston.Texas Children’s also operates Texas Children’s Health Plan, the nation’sfirst health maintenance organization created just for children, and TexasChildren’s Pediatrics, the nation’s largest pediatric primary care network, withover 50 locations across Houston. Texas Children’s Specialty Care and TexasChildren’s Urgent Care locations provide additional enhanced access to carethroughout the Greater Houston community.In 2018, we expanded our care even further, all the way to the capital city ofAustin. The first Texas Children’s Urgent Care opened in March 2018 to bringconvenient, affordable, high-quality after-hours pediatric care to Austin areafamilies. Additionally, three Texas Children’s Pediatrics practices and a TexasChildren’s Specialty Care location staffed by Texas Children’s board-certifiedphysicians, therapists and clinical staff, opened in Austin in 2018.
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8H E A RT C E N T E R O U TC O M E S 2 018PROGRAMS(IN ALPHABETICAL ORDER)
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10H E A RT C E N T E R O U TC O M E S 2 018Texas Children’s Heart Center is committed to settinga new standard for the treatment of children andadults with congenital heart disease and to pioneeringinnovative therapies for patients with cardiac conditions.
H E A RT C E N T E R O U TC O M E S 2 018ADULT CONGENITAL HEART DISEASEThe Adult Congenital Heart Disease (ACHD)program at Texas Children’s Hospital, the largestACHD program in Texas, allows patients withcongenital heart disease to receive seamlesscontinuity of care from birth throughout adulthood.As pediatric patients with congenital heart defectstransition into adulthood, our multidisciplinary teamof experienced congenital heart disease specialistsadvises them on health and lifestyle choices for theiradult needs, including physical challenges, exerciseoptions and family planning.Our program offers comprehensive medical andsurgical care backed by state-of-the-art technologiesand research from our world-class institutions.We provide the full range of ACHD servicesand specialties including surgery, diagnostic andinterventional cardiac catheterization, noninvasiveimaging (including cardiac MRIs and coronary CTangiography), arrhythmia services and more.The ACHD program is accredited by the AdultCongenital Heart Association (ACHA) and is one ofonly three programs accredited in Texas.To achieve this distinction, Texas Children’s had tomeet ACHA’s criteria for medical/surgical servicesand personnel requirements and go through arigorous accreditation process developed overa number of years through a collaboration withdoctors, physician assistants, nurse practitioners,nurses and adult congenital heart diseasepatients. We are also one of only 21 programsin the country with an Accreditation Councilfor Graduate Medical Education ACHD trainingprogram and the only program in Texas that offersthis training opportunity.11
12H E A RT C E N T E R O U TC O M E S 2 018ACHD CLINIC ENCOUNTERSVolume by c visits20172018PatientsCATHETERIZATION CASESPatient age 806040200201420152016CasesPatients20172018
H E A RT C E N T E R O U TC O M E S 2 018CARDIAC DEVELOPMENTAL OUTCOMESThe Cardiac Developmental Outcomesprogram (CDOP) provides routine longitudinalneurodevelopmental follow up byboard-certified developmental-behavioralpediatricians, neurodevelopmental disabilitypediatricians and child psychologists for all childrenwho undergo surgery for congenital heart diseaseduring the first three months of life. The CDOPteam also provides longitudinal monitoring forchildren and adolescents with congenital heartdisease and neurodevelopmental concerns whoare referred by pediatric cardiologists and otherproviders. Our program is the most mature andcomprehensive developmental outcomes programin Texas, and we see not only Texas Children’sHospital patients, but children from other programsacross the state.Over the past year, our clinic has continued to grow,as has our clinic team and the number of clinic days.We welcomed our new research coordinator whohas worked with the clinicians to further develop ourstate-of-the-art database. In addition to providing anoutstanding clinical service, we are participating innational quality initiatives and increasing our researchplatform with multiple current and upcomingprojects. These projects will evaluate outcomes forour patients as well as interventions taking place andresources being provided as part of their routinecare within the CDOP clinic.CARDIAC DEVELOPMENTAL OUTCOMES PROGRAM CLINIC VISITSVolume by 2017201813
14H E A RT C E N T E R O U TC O M E S 2 018CARDIAC IMAGINGOur noninvasive imaging lab performs more than31,000 echocardiograms annually for fetuses, infants,children and adults with congenital or acquired heartdisease. We provide transesophageal, epicardial,intracardiac and transthoracic echocardiographicsupport in the catheterization labs, operating roomsand intensive care units on a daily basis. Our imagingteam now consists of 38 highly trained sonographersand more than 35 faculty members, a dedicatedadvanced practice provider for sedation, as well asnurses, medical assistants and clerical staff.In September 2018, our team moved into its newhome in the Lester and Sue Smith Legacy Tower.We now have 15 transthoracic echo imaging roomswith a six-bed sedation bay. In the new building, wecreated unique pods where echo imaging roomsare nested adjacent to clinic rooms to promotecommunication between imaging and clinicalteams and improve our patient/family experience.State-of-the-art multiphysician “Mission Control”reading rooms are embedded between our pods,giving echo faculty the ability to watch live imagingfrom within the echo lab and in patient care unitsthroughout the hospital.Echocardiographic services are also provided at allof the Texas Children’s Specialty Care locationsand we have additional imaging centers at TexasChildren’s Hospital West Campus and TexasChildren’s Hospital The Woodlands to support ourservices in the community.ECHOCARDIOGRAMSVolume by location449Texas Children's Hospital3,790Texas Children's Hospital West Campus2,556Texas Children's Hospital The Woodlands3,04321,573Texas Children's Specialty Care locationsCommunity hospitals
H E A RT C E N T E R O U TC O M E S 2 018Cardiac MRI & CTThe diagnostic imaging capabilities of cardiac MRI andCT provide an excellent complement to the primaryimaging modality, echocardiography. With advancesin technology that allow rapid imaging with minimalradiation, cardiac CT has become vital in the diagnosisand surgical planning for many of our patients withcongenital heart disease. For neonates with complexcongenital heart disease, we use cardiac CT toprovide rapid and excellent diagnostic information,typically without the need for sedation. For our singleventricle patients, we often employ cardiac CT priorto each surgical endeavor to supply information aboutthe extracardiac anatomy to our surgeons.Our cardiac MRI program continues to grow and iscurrently one of the largest in North America. Thismodality provides a wealth of information in multipleareas, including anatomy, morphology, volumetricand functional data, as well as physiologic informationregarding blood flow. This imaging modality isfrequently used in our teenage and adult congenitalpopulations because of the valuable informationit provides and the limitations of transthoracicechocardiography among this population.In late 2018, we opened our new hybrid cardiacMRI/interventional cardiac catheterization suite.This addition allows us to meld these two procedurestogether to combine the strengths of both modalities,decrease the use of radiation, and eventually performMRI-guided cardiac catheterizations.CARDIAC MRI & CT PROCEDURESVolume by 458400300200100020142015Cardiac MRI2016Cardiac CT2017201815
16H E A RT C E N T E R O U TC O M E S 2 018Pharmacologic Cardiac Stress MRIAt Texas Children’s Hospital, we are proud to haveone of the busiest pediatric stress MRI programsin the world. There are numerous pediatric cardiacdiseases that may be a cause of myocardial ischemia.Cardiac MRI is an excellent diagnostic tool toexamine the cardiac function, perfusion and viabilityin these unique populations. As part of our robustCoronary Artery Anomalies program, the majorityof patients undergo a dobutamine stress MRI aspart of their diagnostic work-up. For patients atrisk of coronary ischemia, including those with anarterial switch operation or a diagnosis of Kawasakidisease, we are one of only a few pediatriccenters in the U.S. to offer regadenoson as apharmacologic stress agent. These tests requirea dedicated, coordinated effort from a team ofexperts including a pediatric cardiologist, pediatricradiologist, cardiac nurse, cardiac MRI technologistand MRI physicist. In 2018, our program performed113 cardiac stress MRI examinations.Advances in Cardiac Imaging Hypoplastic left heart syndrome (HLHS) is acomplex cyanotic heart defect requiring threesurgical palliations in the first three years of life.To better assess for changes in function of thesingle right ventricle in these patients over time,we instituted a prospective imaging protocol overa more than two year period using cardiac straintechnology, which assesses deformation of thecardiac muscle. The advantage of strain is that itis a quantitative measure with high reproducibility.The outcomes of this work have been accepted forpublication in an upcoming issue of the Journal ofthe American Society of Echocardiography. We foundthat strain indices in patients between the Norwoodand Glenn stages are worse in HLHS infants wholater have a poor cardiac outcome. This may help usbetter identify at-risk patients and has the potentialto change practice as we incorporate this modalityinto the care of these patients. With industry support, we are currently evaluatingthe clinical utility of blood speckle imaging (BSI).Blood cells traveling through a heart chamber orvalve produce flow variations such as vortices andhelix formations. We are looking at ascertainingnormal and abnormal intracardiac flow patternswithout using injected contrast or invasivemethods. We are also now collecting simultaneous4D data evaluation by MRI to assist in theevaluation of flow through the cardiac valves. The impact of chemotherapy on ventricularfunction in children is being increasinglyrecognized. As part of our Cardio-Oncologyinitiative, we have adopted strict standardsfor detailed ventricular functional analysis andincluded myocardial strain. Our goals are toimprove accuracy and consistency of functionalassessment, detect earlier identification ofcancer therapy-related cardiac dysfunction anddetermine best practices for coordinating carewith our Hematology-Oncology colleagues. Uponrecent early review of this initiative, we found wehave been successful in decreasing variability inassessing cardiac function through these changesto our operating procedure. Evaluating diastolic dysfunction (abnormalities inrelaxation of the heart) in pediatric patients is achallenge. We are investigating left atrial strainanalysis as a potentially important tool to assessfor early diastolic abnormalities in patients whohave had cardiac transplant and in those treatedwith anthracyclines as part of their cancer therapy.Both projects are currently under considerationfor publication. 3D evaluation of cardiac anatomy and functionis performed to provide more completeimaging details essential in preoperative orprecatheterization intervention planning, and toassist in functional assessment over time.
H E A RT C E N T E R O U TC O M E S 2 018CARDIAC INTENSIVE CARE UNITThe Cardiac Intensive Care Unit (CICU) at TexasChildren’s Hospital strives for continued excellencein the care of infants, children and adults withcomplex cardiac disease. The patient- and familyfocused multidisciplinary care delivery model issupported by some of the best specialists andcare providers in the nation, ensuring the highestlevel of clinical support for some of the sickestchildren in our region and beyond. In September2018, together with the entire Heart Center,the CICU moved to our new home – the Lesterand Sue Smith Legacy Tower – which houses 48state-of-the-art CICU rooms, all with dedicatedfamily space. The unit spans three floors, indirect adjacency or vertical proximity with thecardiovascular operating rooms, catheterizationlaboratory, MRI scanners, interventional radiologysuites and all other support services. The newCICU is also collocated with the 84-bed PediatricIntensive Care Unit.CICU PATIENT ADMISSIONSVolume by ,0801,0601,0401,0451,0201,00098020152016The CICU TeamThe CICU is staffed by a highly experienced,multidisciplinary team of physicians, advancedpractice providers, nurses, respiratory therapistsand pharmacists, as well as a nutrition team, physicaltherapists and occupational therapists. All membersof the team and the patient families are includedin multidisciplinary rounding with shared decisionmaking. We are actively involved in numerouscollaborative clinical, quality and research initiatives.Our growing group of dedicated CICU advancedpractice providers, together with more than 40ACGME fellows in cardiology and critical caremedicine, provide patient care under the supervisionof our 33 cardiac intensivists with subspecialty20172018training in pediatric critical care, cardiology,neonatology and cardiac anesthesia. The CardiacCritical Care Instructorship program is nationallyrecognized for innovations and leadership in trainingthe next generation of pediatric cardiac intensivists.Specialized complex care patient teams monitorpatient progress, developing plans for interventionsand optimizing supportive therapies to achieve thebest outcomes in some of the most complex patientpopulations, such as patients with hypoplasticheart syndrome. A dedicated Heart CenterRapid Response Team is staffed by intensive careattendings, fellows and nurses, ensuring timelyescalation of care and transport of patients to ahigher level of care.17
H E A RT C E N T E R O U TC O M E S 2 018Subspecialty Cardiac Intensive CareOur new environment includes increased capacityand four pods with 12 beds each, allowing us tofurther expand our subspecialty focus for critically illchildren with heart disease. We also have a 12-beddedicated Heart Failure Intensive Care Unit, thefirst of its kind in the nation, which focuses on thetreatment of children with heart failure and thoserequiring intensive care before and after hearttransplant including both durable and temporarymechanical circulatory support strategies. Inaddition, we have a new neonatal CICU to whichwe admit newborns before and after surgery andare able to focus on their developmental care whileattending to the specific needs of their families.Quality and OutcomesThe CICU’s outcomes and performance are closelymonitored through participation in national registriesincluding Pediatric Critical Care Consortium (PC4),Extracorporeal Life Support Organization (ELSO),Society of Thoracic Surgery (STS) and PediMACS.Our Heart Failure ICU is an active participant in theAdvanced Cardiac Therapies Improving OutcomesNetwork (ACTION) collaborative focusing onimproving outcomes for pediatric ventricularassist device patients. Patient safety and qualityare approached by our quality team, with regularreviews of all of our practices and procedures.Internal audit routinely includes benchmarkingour performance alongside other high volumeU.S. centers.One of our recent focuses has been on reducingthe incidence of catheter-associated bloodstreaminfections. Our multidisciplinary team of critical careclinical nurse specialists, intensive care physicians,quality specialists and the Texas Children’s InfectionControl team have developed a central linestewardship team with 40 team members. Throughthis, we introduced multiple initiatives including newcare bundles, rapid multidisciplinary reviews of anysuspected hospital-acquired infection, nurse-ledrounding tools and dress codes in all ICU areas.CICU COMPLICATIONS5.0Percentage of .00.480.0UnplannedExtubationsCardiac Arrestafter SurgeryTexas Children’s HospitalData from PC4 registryCardiac Arrest inMedical AdmissionsNecrotizing Enterocolitisin Surgical PatientsHigh volume centers
H E A RT C E N T E R O U TC O M E S 2 018CENTRAL LINE STEWARDSHIPTeam Members vs. ProjectsTeam macy4Quality SpecialistsExtracorporeal CardiopulmonaryResuscitationExtracorporeal cardiopulmonary resuscitation(ECPR) refers to the initiation of lifesavingextracorporeal membrane oxygenation (ECMO)in the setting of cardiac arrest. Successful ECPRoutcomes require rapid decision-making and carefulteam training to ensure that patients receive ECMOas quickly as possible. Texas Children’s HeartCenter is committed to working towards more rapidinitiation of the support with an improved call-outand response system, and enhancement of theavailability of key personnel around the clock.In early 2018, the Heart Center and Perioperativeteams embarked upon a major multidisciplinaryinitiative to develop a robust, unified response tominimize the time taken to initiate ECMO. Oneimportant step was to introduce round-the-clockin-house ECMO circuit primers – highly trainedexperts in the setup of the complex ECMO circuits– helping us to avoid any delays in readiness toinitiate ECMO. In addition, we introduced a unifiedcall-out mechanism that placed the responsibility ofdecision-making on the CICU medical and nursingteam with simultaneous notification of all key teamTransparencyEducationmembers. Finally, between January and March 2018,we conducted a series of high-fidelity simulationexercises to test the system and train the team.International CollaborationsOur CICU team has established strong links withcardiac teams in several countries within LatinAmerica. Through videoconferences with ourcolleagues in Mexico City, we have establishedregular virtual ward rounds and additionalcommunication forums, rounding with the localcardiac surgeons and intensivists in their two maincardiac centers. In 2018, we held more than 70video-conference ward rounds in the two CICUsin Mexico City, assisting with patient management,sharing of protocols, establishing new or innovativetherapies including ECMO, and recommendingquality improvement initiatives. In addition,together with many Heart Center colleagues,our critical care team has active educational andsimulation-based collaborations with severalcenters in Latin America (Mexico, Chile, Colombia,Argentina and Costa Rica) aimed at developingadvanced perioperative cardiac care and toestablish and maintain ECMO programs.19
20H E A RT C E N T E R O U TC O M E S 2 018CARDIOLOGY TRANSITION MEDICINEWe are committed to helping our patients withcongenital heart disease (CHD) who are approachingadulthood make a smooth transition from pediatricto adult health care. We have developed a uniquetransition program that serves adolescents with CHDby performing individual
4 HEART CENTER OUTCOMES 2018 TEXAS CHILDREN'S HEART CENTER Texas Children's Hospital has been a leader in pediatric heart care for more than 60 years. Led by Denton Cooley, M.D., and Dan McNamara, M.D., the hospital started performing heart surgery on children in 1956. Dr. McNamara, a patriarch of pediatric cardiology, and Dr. Cooley, a .
4 HEART CENTER OUTCOMES 2018 TEXAS CHILDREN'S HEART CENTER Texas Children's Hospital has been a leader in pediatric heart care for more than 60 years . Led by Denton Cooley, M .D ., and Dan McNamara, M .D ., the hospital started performing heart surgery on children in 1956 . Dr . McNamara, a patriarch of pediatric cardiology, and Dr .
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a heart attack. Having high blood pressure can lead to heart failure. A buildup of cholesterol and fat in the arteries of the heart can lead to heart failure. Abnormal heart valves can lead to heart failure. Heart failure is a con
Malfunctioning of heart leads to heart disease and there are multiple forms of heart disease. Electrocardiogram (ECG) is painless and basic test which can detect basic heart related problems. Heart beat variations can be identified by detecting heart beat peaks. Heart beat peak detection plays a vital role for efficient analysis of ECG signals.
The protein that is formed? Gene Expression DNA has many regions, some of them are coding regions – the genes which code for proteins, and other regions are non-coding regions which can switch the genes on or off and therefore determine if they will be expressed (if their protein will be produced) or not. Your cells have all of your genes but your cells don’t need to express all of these .
