Kimberlee Gauvreau

Harvard University | Harvard · Department of Biostatistics

Background: Ventricular pacing can cause myocardial dysfunction but how lead anchoring to myocardium affects function has not been studied. Objective: Evaluate patterns of regional and global ventricular function in patients with a ventricular lead using cine cardiac computed tomography (CCT) and histology. Methods: This was a single center re...

Introduction Patients with congenital heart disease (CHD) have variable degrees of peak oxygen consumption (VO 2 ) that can be improved with supervised fitness training. The ability to exercise is affected by anatomy, hemodynamics, and motivation. Motivation is in part related to mindset, or personal attitudes and beliefs, and a more positive minds...

Objectives To define the incidence of definitive necrotising enterocolitis in term infants with CHD and identify risk factors for morbidity/mortality. Methods We performed a 20-year (2000–2020) single-institution retrospective cohort study of term infants with CHD admitted to the Boston Children’s Hospital cardiac ICU with necrotising enterocoliti...

Objective: We sought to develop a novel risk prediction model of one-year mortality following congenital heart surgery that accounts for clinical, anatomic, echocardiographic, and socioeconomic factors. Methods: This was a single-center, retrospective review of consecutive index operations for congenital or acquired heart disease, from 01/2011-0...

Objective: We sought to characterize the natural history of aortic root dilatation and aortic regurgitation (AR) in tetralogy of Fallot (TOF). Methods: A single-center review of patients who underwent TOF repair from 01/1960-12/2022 was performed. Morphology was categorized as TOF-pulmonary stenosis (TOF-PS) or TOF-variant (including TOF-pulmona...

Objective: To utilize neighborhood-level child opportunity index (COI) measures to investigate disparities in congenital heart surgery post-operative outcomes and identify potential targets for intervention. Study design: In this single-institution retrospective cohort study, children <18 years old who underwent cardiac surgery between 2010 and...

Background No published data are available on the patient, procedural characteristics, and outcomes of congenital heart disease (CHD) cardiac catheterization performed in low- and middle-income countries (LMICs). Objectives The objective of this study was to describe procedural characteristics and patient outcomes of CHD cardiac catheterizations i...

Background: In single-ventricle patients undergoing staged-bidirectional Glenn, 36-59% have aorto-pulmonary collateral flow, but risk factors and clinical outcomes are unknown. We hypothesise that shunt type and catheter haemodynamics may predict pre-bidirectional Glenn aorto-pulmonary collateral burden, which may predict death/transplantation, pu...

As new variants of SARS-Co-V 2 have emerged over time and Omicron sub-variants have become dominant, the severity of illness from COVID-19 has declined despite greater transmissibility. There are fewer data on how the history, diagnosis, and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) have changed with evolutio...

Objective: To assess the extent and resolution of pulmonary hypertension (PH), cardiovascular factors, and echocardiographic findings associated with mortality in infants and children with vein of Galen malformation (VOGM). Study design: We performed a retrospective review of 49 consecutive children with VOGM admitted to Boston Children's Hospit...

Background: The natural history of the dilated truncal root in repaired truncus arteriosus (TA) is incompletely understood. Methods: A single-center review of patients who underwent TA repair from 01/1984-12/2018 was performed. Echocardiographically-determined root diameters and derived z-scores were measured at the annulus, sinus of Valsalva (S...

Our primary aim was to investigate the relationship between LVM and anthropometric measures including lean body mass (LBM) in obese pediatric subjects compared to normal weight controls. A retrospective chart review identified subjects 2–18 years old who were normotensive and had normal echocardiograms between 1995 and 2020 at Boston Children’s Hos...

Background The impact of neighborhood socioeconomic status (SES) on outcomes following first‐stage palliation of single ventricle heart disease remains incompletely characterized. Methods and Results This was a single‐center, retrospective review of consecutive patients who underwent the Norwood procedure from January 1, 1997 to November 11, 2017....

Patients with pulmonary vein stenosis (PVS) often require frequent transcatheter pulmonary vein (PV) interventions for management of restenosis. Predictors of serious adverse events (AEs) and need for high-level cardiorespiratory support (mechanical ventilation, vasoactive support, and/or extracorporeal membrane oxygenation) 48 h after transcathete...

Background: DOAC use in pediatric cardiology is poorly defined. Objective: We present the largest experience of apixaban use in children with heart disease, using weight- and level-based dosing. Methods: Retrospective single-center analysis of cardiac patients ≤19 y treated with apixaban. Patients were evaluated for safety (clinically relevant...

Background: Strict visitor restrictions during the COVID-19 pandemic have been associated with staff moral distress in numerous clinical settings, yet little is known about effects on perceptions of pediatric end-of-life care. Objective: To determine the effect of COVID-19 visitor restrictions on perceptions of quality of dying and death. Metho...

Background Patients with pulmonary vein stenosis (PVS) often require frequent transcatheter pulmonary vein (PV) interventions for management of restenosis. Predictors of serious adverse events (AEs) and need for high-level cardiorespiratory support (mechanical ventilation, vasoactive support, and/or extracorporeal membrane oxygenation) 48 hours aft...

Objectives While procedure length is considered an important metric for cardiothoracic surgical procedures, the relationship between procedure length and adverse events (AEs) in congenital cardiac catheterizations has little published data available. Furthermore, most existing congenital cardiac catheterization risk prediction models are built on l...

Objective We sought to identify associations between prenatal care coordination (PNC) and outcomes in hypoplastic left heart syndrome (HLHS). Study design We hypothesized that suboptimal PNC is associated with worse pre-operative status. HLHS patients from 2016 through 2019 were identified using a multicenter registry. Optimal PNC was defined as (...

Objective As COVID-19 continues to affect the global population, it is crucial to study the impact of the disease in vulnerable populations. This study of a diverse, international cohort aims to provide timely, experiential data on the course of disease in paediatric patients with congenital heart disease (CHD). Methods Data were collected by capi...

Children with chronic medical conditions, including heart disease, have increased susceptibility to behavioral health concerns. We sought to evaluate the feasibility and parental opinion of anxiety screening in pediatric cardiology clinic. The PROMIS Pediatric Anxiety v2.0 Short Form 8a (PA2-S8) questionnaire was administered to 48 patients present...

BACKGROUND Early post-operative catheterizations (EPOC) within six weeks after congenital heart surgery can treat residual lesions and provide important clinical information. However, EPOC are often assumed to impose additional risk on a vulnerable patient population. This study aimed to describe the EPOC population, evaluate procedural safety, com...

Objectives: The study objectives were to report on a growing experience of conduction system mapping during complex congenital heart surgery and create a predictive model of conduction anatomy. Methods: Patients undergoing complex cardiac repair with conduction mapping were studied. Intraoperative mapping used a multielectrode catheter to collec...

Objectives The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries. Design A mixed-methods approach was used. Setting Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for cong...

Introduction: Ventricular pacing can cause dysfunction but how the lead is anchored to the myocardium has not been studied. We evaluated patterns of regional and global ventricular function in patients with a ventricular pacemaker or defibrillator using cine cardiac CT (CCT). Methods: This was a single center retrospective study of patients with a...

Introduction: High energy requirements and poor feeding due to left-to-right shunting can lead to growth failure in patients with ventricular septal defect (VSD) but the effect of malnutrition on surgical outcomes is not well known, especially in low-resource settings. More data would inform decisions on whether nutritional repletion should occur p...

Introduction: Peak oxygen consumption (pVO 2 ) is a marker of cardiovascular fitness. While anthropometric data are incorporated into predictive equations, like the Cooper equation, social determinants of health are not. We hypothesized that socioeconomic status (SES) has a greater effect than standard demographic values on predicted pVO 2 in a con...

Introduction: The multifaceted pathways through which a child’s environment impacts outcomes following congenital cardiac surgery remain incompletely characterized. Hypothesis: We hypothesized that childhood opportunity, measured using a US census-track-based, nationally-normed composite metric of contemporary neighborhood opportunity comprising 29...

Introduction: The Residual Lesion Score (RLS) has recently been validated as an important predictor of outcomes following congenital heart surgery. However, its reliance on the pre-discharge echocardiogram limits its utility. We assessed the intraoperative RLS (IO-RLS) as a predictor of outcomes following congenital cardiac surgery. Hypothesis: We...

Introduction: Patients with repaired tetralogy of Fallot (rTOF) often require pulmonary valve replacement (PVR). Transcatheter PVR is a less invasive alternative to surgery but many right ventricular outflow tracts (RVOTs) are too large. Understanding the rate of RVOT growth may help optimize timing of referral. This study examined the growth of th...

Introduction: Noonan syndrome (NS) is an autosomal dominant genetic disorder associated with a high incidence of cardiovascular disease. We sought to investigate pulmonary hypertension (PH) in patients with NS, as well as characterize the hemodynamics, cardiovascular interventions, genetics, and transplant-free survival. Methods: A retrospective, d...

Introduction: Anatomic characterization of pulmonary blood flow is of paramount importance in patients with major aortopulmonary collaterals (MAPCAs). Although computed tomography angiography (CTA) is an appealing alternative to cardiac angiography (CA), its ability to differentiate between single- versus dual-supply MAPCAs is not well-established....

Introduction: There are few modifiable risk factors for adverse neurodevelopmental (ND) outcomes in congenital heart disease. We assessed the Residual Lesion Score (RLS), a quality improvement metric that assesses residual lesion severity following congenital heart surgery (CHS), as a predictor of ND delay. Hypothesis: We hypothesized that RLS woul...

Background The Coronavirus disease 2019 (COVID-19) pandemic has posed tremendous stress on the health care system. Its effects on pediatric/congenital catheterization program practice and performance have not been described. Objectives To evaluate how case volumes, risk-profile, and outcomes of pediatric/congenital catheterization procedures chang...

Background Patients with a systemic right ventricle (SRV) and biventricular circulation experience high incidence of cardiovascular morbidities and decreased survival [1]. Non-invasive measures of subclinical ventricular dysfunction are needed to appropriately identify patients at increased risk for adverse outcomes. Ventricular-arterial coupling (...

Background: While singular measures of socioeconomic status have been associated with outcomes after surgery for congenital heart disease, the multifaceted pathways through which a child's environment impacts similar outcomes remain incompletely characterized. We sought to evaluate the association between childhood opportunity level and adverse ou...

Risk stratification is required to set an exercise prescription for cardiac rehabilitation, but an optimal scheme for congenital heart disease (CHD) is unknown. We piloted a system based on hemodynamic rather than anatomic factors: function, oxygen level, rhythm, complex/coronary anatomy, and elevated load (FORCE). Feasibility, efficacy, and safety...

Background Outcomes following congenital aortic valve (AoV) repair are plagued by progressive dysfunction of currently available leaflet substitute materials. Objectives We compared the long-term outcomes of congenital AoV repair using porcine intestinal submucosa vs autologous pericardium (AP). Methods This was a single-center retrospective revi...

BACKGROUND We sought to validate the technical performance score (TPS) as a predictor of mid-term outcomes following congenital aortic valve repair. METHODS This was a single-center, retrospective review of consecutive patients who underwent aortic valve repair from 01/2011-01/2020. Pre-discharge echocardiograms were used to assign TPS for each in...

Risk stratification is required to set an exercise prescription for cardiac rehabilitation, but an optimal scheme for congenital heart disease (CHD) is unknown. We piloted a system based on hemodynamic rather than anatomic factors: Function, Oxygen level, Rhythm, Complex/Coronary anatomy, and Elevated load (FORCE). Feasibility, efficacy, and safety...

Background Data regarding the impact of intraoperative residual lesions on extracorporeal membrane oxygenation (ECMO) following the Norwood procedure are limited. Moreover, the significance of postoperative ECMO timing on in-hospital outcomes remains incompletely characterized. Methods This was a single-center, retrospective review of consecutive...

Background: Cardiac allograft vasculopathy (CAV) is a leading cause of long-term morbidity and mortality in pediatric heart transplant (HTx) recipients. Exercise stress echocardiography (ESE) has been shown to be useful in the detection of angiographically-confirmed CAD in children. However, the prognostic utility of ESE for prediction of cardiac...

Objectives: Currently, there are no prediction tools available to identify patients at risk of needing high-complexity care following cardiac catheterization for congenital heart disease. We sought to develop a method to predict the likelihood a patient will require intensive care level resources following elective cardiac catheterization. Design...

Background: Outcomes following TAPVC repair remain suboptimal due to recurrent pulmonary vein (PV) obstruction requiring reinterventions. We sought to develop a clinical prediction rule for PV reintervention following total anomalous pulmonary venous connection (TAPVC) repair. Methods: Data from consecutive patients who underwent TAPVC repair at...

Background Catheter‐based slow‐pathway modification (SPM) is the treatment of choice for symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). We sought to investigate the interactions between patient age and procedural outcomes in pediatric patients undergoing catheter‐based SPM for AVNRT. Methods and Results A retrospective cohort st...

Background Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting. Methods An infrastructure survey was administered to sites participating in the International Quality Improveme...

Exercise function is well characterized in adults with hypertrophic cardiomyopathy (HCM); however, there is a paucity of data in children and young adults with HCM. Here we sought to characterize exercise function in young people with HCM, understand limitations in exercise function by correlating exercise function parameters with echocardiogram pa...

Background Unplanned catheter-based or surgical reinterventions after congenital heart operations are independently associated with operative mortality and increased postoperative length of stay. Objectives This study assessed the long-term outcomes of transplant-free survivors of hospital discharge requiring predischarge reinterventions after con...

Importance: Lack of pediatric end-of-life care quality indicators and challenges ascertaining family perspectives make staff perceptions valuable. Cardiac intensive care unit (CICU) interdisciplinary staff play an integral role supporting children and families at end of life. Objectives: To evaluate the Pediatric Intensive Care Unit Quality of D...

(242/250 Words) Objective Outcomes following first-stage palliation of single-ventricle heart disease are influenced by many factors, including the presence of residual lesions requiring reintervention. However, there is a dearth of information regarding the optimal timing of reintervention. We assessed if earlier reintervention would be favorably...

BACKGROUND The utility of the intraoperative TPS (IO-TPS) in predicting outcomes following congenital cardiac surgery remains unknown. METHODS Data from patients undergoing surgery for congenital heart disease from 01/2011-12/2019 at a single institution were retrospectively reviewed. Intraoperative echocardiograms were used to assign IO-TPS for e...

Background While the pre-discharge technical performance score (DC-TPS) is significantly associated with outcomes following congenital cardiac surgery, the utility of the intraoperative TPS (IO-TPS) remains unknown. Methods This was a single-center retrospective review of consecutive patients who underwent congenital cardiac surgery from 01/2011-1...

Purpose A recent multi-center study (CTOT-04) reported similar first year outcomes in children with CDC T-cell crossmatch (XM) + and XM- heart transplant (HT) but was underpowered and had only 11 children in the CDC+ HT group. We assessed the association of donor specific T-cell CDC and Flow XM HT with the risk of rejection and allograft loss in US...

Purpose Despite extracorporeal membrane oxygenation (ECMO) utilization in up to 20% of cases, there are limited outcome data in pediatric patients with acute fulminant myocarditis (AFM) requiring mechanical circulatory support. Methods Retrospective cohort of patients <18 years with AFM admitted to a single center cardiac ICU and supported with EC...

The objective of this study was to evaluate the impact of the regular introduction of new technologies into interventional cardiac catheterization procedures, in this case new atrial septal defect (ASD) closure devices, while conducting a multi-center collaborative initiative to reduce radiation usage during all procedures. Data were collected pros...

Background The incidence of pregnancy in women with cardiovascular disease (CVD) has increased, yet little is known about placental pathology in these women. Objectives The objectives of this study were to describe placental pathology in pregnancies complicated by maternal CVD and to compare findings among categories of maternal CVD. Methods A re...