David J. Driscoll

Oklahoma State University - Tulsa, Tulsa, Oklahoma, United States

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Publications (192)1316.96 Total impact

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    ABSTRACT: We reviewed records of all patients with an initial Fontan operation or revision from 1973 to 2012 at our institution (n = 1,138); 195 patients had postoperative liver data available. Cirrhosis was identified by histopathology or characteristic findings on imaging with an associated diagnosis of cirrhosis by a hepatologist. Of 195 patients with biopsy or imaging, 10-, 20-, and 30-year freedom from cirrhosis was 99%, 94%, and 57%, respectively. There were 40 of 195 patients (21%) diagnosed with cirrhosis (mean age at Fontan 10.7 ± 8 years). On multivariate analysis, hypoplastic left heart syndrome was associated with increased risk of cirrhosis (n = 2 of 16, p = 0.0133), whereas preoperative sinus rhythm was protective (p = 0.009). Survival after diagnosis of cirrhosis was 57% and 35%, at 1, and 5 years, respectively. The cause of death was known for 9 patients (5 multiorgan failure, 2 liver failure, and 2 heart failure). In conclusion, there is an incremental occurrence of cirrhosis after the Fontan, which should be considered when designing follow-up protocols for patients after Fontan operation.
    No preview · Article · Nov 2015 · The American journal of cardiology
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    ABSTRACT: There are limited long-term, single-cohort, follow-up studies available about patients after the Fontan operation.
    Full-text · Article · Oct 2015 · Journal of the American College of Cardiology

  • No preview · Article · May 2015 · Congenital Heart Disease
  • K. Pundi · D. Driscoll · J. Dearani · S. Dahl · P. O'Leary · R. Daly · F. Cetta · J. Johnson

    No preview · Article · May 2015 · Pediatric Transplantation
  • K.N. Pundi · K. Pundi · J.N. Johnson · Z. Li · P.W. O’Leary · D.J. Driscoll · F. Cetta

    No preview · Article · Apr 2015 · The Journal of Heart and Lung Transplantation
  • K. Pundi · K.N. Pundi · J.N. Johnson · Z. Li · D.J. Driscoll · F. Cetta

    No preview · Article · Apr 2015 · The Journal of Heart and Lung Transplantation
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    ABSTRACT: Klippel-Trenaunay syndrome (KTS) is a mixed mesenchymal malformation characterised by varicose veins, venous and capillary malformations, and hypertrophy of soft tissue and bone. The purpose of this study was to evaluate the surgical outcomes in KTS patients to provide standards for comparison with endovenous therapy. The clinical data of consecutive patient with KTS who underwent open venous surgical treatment between January 1987 and December 2008 were reviewed. Demographics, clinical presentation, operative data, and clinical outcomes were recorded. Follow-up information was obtained from the medical records, mailed questionnaires and phone calls. Descriptive statistics, the Kaplan-Meier method and Log-rank statistics were used where appropriate. Twenty-seven females and 22 males, (mean age 26.5 years, range 7.7-55.8) were included in this study. All had varicose veins, 36 (73%) had limb hypertrophy, and 33 (67%) had capillary malformations, with two of three clinical features present in all. The most frequent symptom was pain (N = 43, 88%). Forty-nine patients underwent operations on 53 limbs. Stripping of the GSV, small and accessory saphenous and lateral embryonic veins was performed in 17 (32%), 10 (19%), 9 (17%), and 15 (28%) limbs, respectively. Two patients developed deep vein thrombosis, one had pulmonary embolism (PE), and one patient had peroneal nerve palsy. Freedom from disabling pain at 1, 3 and 5 years was 95%, 77% and 59%, respectively, and freedom from secondary procedures was 78% at 3 years, and 74% at 5 years. At the last follow-up visit, the venous clinical severity score had decreased from 9.48 ± 3.27 to 6.07 ± 3.20 (P < 0.001). In selected symptomatic patients with KT syndrome, open surgical treatment is safe and durable. Three-fourths of the patients remain free of disabling pain at five years, but secondary procedures are required in one-fourth of the patients. These data can serve as standards for comparison of endovenous therapy for KT syndrome. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    No preview · Article · Mar 2015 · Phlebology
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    Sameh M. Said · David J. Driscoll · Joseph A. Dearani
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    ABSTRACT: Improvement in surgical techniques, anesthesia, and perioperative care has resulted in the majority of children born with congenital heart defects surviving into adulthood with a normal or near-normal quality of life. A careful transition from pediatric to adult care providers is important to avoid issues related to loss of continuity of care and any undue financial or psychological burdens to the patients and their families. The patients, their families, and the health care providers are faced with many challenges during this transition process that can be optimized and overcome by education about the heart defects and a team approach with clear lines of communication. This review addresses the challenges related to the transition of care from pediatrics to adults and provides the necessary recommendations to ensure a smooth transition process. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Jan 2015 · Seminars in Pediatric Surgery
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    ABSTRACT: Objective: After Fontan operation, hemodynamically significant veno-venous collateral (VVC) vessels can lead to systemic arterial desaturation. Outcomes after embolization of VVCs have not been determined. We sought to determine the frequency of and outcomes for patients undergoing VVCs embolization after Fontan operation. Design: We retrospectively analyzed clinical and hemodynamic data of patients who underwent cardiac catheterization after the Fontan operation from 1995 to 2014 at Mayo Clinic. Clinical, imaging, and hemodynamic data from patients with VVCs were compared based on intervention (embolization) vs. nonintervention. Results: Four hundred ninety-six patients with prior Fontan operation had catheterization; 109 VVCs were identified in 72 patients (37 males, mean age 26 ± 12 years). Embolization was performed in 31/72 patients (43%). Following embolization, no improvement was demonstrated in oxygen saturation or hemoglobin concentration at ambulatory follow-up (2.5 ± 2 years), and cardiac index declined at follow-up catheterization (5.6 ± 3 years). Overall, 15 patients (21%) died at a mean of 2.8 ± 4 years after embolization. Fifty percent of deaths after embolization occurred in patients with Fontan pressures ≥18 mm Hg. Five-year survival of patients with VVCs undergoing embolization was 74% compared with 92% in those patients who did not undergo embolization (P < .01). In multivariate analysis, significant predictors of death on follow-up were embolization [hazard ratio (HR) = 9.3 (95% confidence interval [CI], 2.8-42), P = .0001], atrio-pulmonary Fontan (HR = 4.2 [95% CI, 1.4-15], P = .01), and heterotaxy (HR = 3.7 [95% CI, 1.0-15], P = .05). Conclusion: We observed decreased 5-year survival in patients who had VVC embolization. Embolization of VVC in patients after Fontan should be evaluated very carefully in patients with atrio-pulmonary type Fontan, heterotaxy, and those with Fontan pressure above 18 mm Hg. These patients may benefit from the "natural" fenestration that VVCs provide.
    No preview · Conference Paper · Oct 2014
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    ABSTRACT: Objective: To describe and analyze the cardiopulmonary responses to exercise for patients with repaired tetralogy of Fallot (TOF) before and after pulmonary valve replacement (PVR) and compare our results with those in the literature. Methods: Between 1973 and 2012, 278 patients had a first-time PVR after TOF repair. During their evaluations, 76 patients (27%) had exercise testing before PVR, and 63 (23%) had at least one test after PVR. There were 17 patients (average age at surgery 40 ± 14 years, 65% female) with both pre- and postoperative testing within 36 months of surgery. We then combined our results with previously reported studies for meta-analysis. Results: Patients who had exercise testing before PVR were older compared with those who did not have testing performed (37 ± 13 vs. 30 ± 17 years, P < .001). Preoperatively, patients achieved a peak heart rate of 153 ± 28 bpm and a peak VO2 of 21.5 ± 7.2 mL/kg/min (61 ± 15% of expected). Postoperatively, they achieved a peak heart rate of 156 ± 25 bpm and a peak VO2 of 23.3 ± 6.5 mL/kg/min (67 ± 15% of expected). Paired analysis demonstrated a significant increase in peak VO2 percentage (P = .04) but not for absolute VO2 measurements (mL/kg/min). We identified six published studies with similar usable data. Combining all seven data sets for meta-analysis, there was no significant change in peak VO2 following PVR (P = .2). Conclusions: Patients with repaired TOF have an abnormally low aerobic capacity at the time of PVR. We appreciated a modest improvement in percentage of predicted peak VO2 after PVR; however, meta-analysis of the available literature did not demonstrate an appreciable difference in aerobic capacity following PVR.
    No preview · Article · Aug 2014 · Congenital Heart Disease
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    ABSTRACT: BACKGROUND Patients with protein-losing enteropathy (PLE) following the Fontan operation have a reported 50% mortality at 5 years after diagnosis. OBJECTIVES The aim of this study was to review outcomes in patients with PLE following the Fontan operation. METHODS From 1992 to 2010, 42 patients (55% male) with PLE following the Fontan operation were identified from clinical databases at the Mayo Clinic. Data were collected retrospectively. RESULTS Mean age at PLE diagnosis was 18.9 +/- 11.0 years. Initial Fontan operation was performed at 10.1 +/- 10.8 years of age. Mean time from Fontan operation to PLE diagnosis was 8.4 +/- 14.2 years. Survival was 88% at 5 years. Decreased survival was seen in patients with high Fontan pressure (mean > 15 mm Hg; p 0.04), decreased ventricular function (ejection fraction < 55%; p 0.03), and New York Heart Association functional class > 2 at diagnosis (p 0.04). Patients who died had higher pulmonary vascular resistance (3.8 +/- 1.6 Wood units [WU] vs. 2.1 +/- 1.1 WU; p 0.017), lower cardiac index (1.6 +/- 0.4 l/ min/ m2 vs. 2.7 +/- 0.7 l/ min/ m2; p < 0.0001), and lower mixed venous saturation (53% vs. 66%; p 0.01), compared with survivors. Factors were assessed at the time of PLE diagnosis. Treatments used more frequently in survivors with PLE included spironolactone (21 [68%]), octreotide (7 [21%]), sildenafil (6 [19%]), fenestration creation (15 [48%]), and relief of Fontan obstruction (7 [23%]). CONCLUSIONS PLE remains difficult to treat; however, in the current era, survival has improved with advances in treatment. Further study is needed to better understand the mechanism of disease and ideal treatment strategy. (C) 2014 by the American College of Cardiology Foundation.
    Preview · Article · Jul 2014 · Journal of the American College of Cardiology
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    ABSTRACT: Background Patients with protein-losing enteropathy (PLE) following the Fontan operation have a reported 50% mortality at 5 years after diagnosis. Objectives The aim of this study was to review outcomes in patients with PLE following the Fontan operation. Methods From 1992 to 2010, 42 patients (55% male) with PLE following the Fontan operation were identified from clinical databases at the Mayo Clinic. Data were collected retrospectively. Results Mean age at PLE diagnosis was 18.9 ± 11.0 years. Initial Fontan operation was performed at 10.1 ± 10.8 years of age. Mean time from Fontan operation to PLE diagnosis was 8.4 ± 14.2 years. Survival was 88% at 5 years. Decreased survival was seen in patients with high Fontan pressure (mean >15 mm Hg; p = 0.04), decreased ventricular function (ejection fraction <55%; p = 0.03), and New York Heart Association functional class >2 at diagnosis (p = 0.04). Patients who died had higher pulmonary vascular resistance (3.8 ± 1.6 Wood units [WU] vs. 2.1 ± 1.1 WU; p = 0.017), lower cardiac index (1.6 ± 0.4 l/min/m2 vs. 2.7 ± 0.7 l/min/m2; p < 0.0001), and lower mixed venous saturation (53% vs. 66%; p = 0.01), compared with survivors. Factors were assessed at the time of PLE diagnosis. Treatments used more frequently in survivors with PLE included spironolactone (21 [68%]), octreotide (7 [21%]), sildenafil (6 [19%]), fenestration creation (15 [48%]), and relief of Fontan obstruction (7 [23%]). Conclusions PLE remains difficult to treat; however, in the current era, survival has improved with advances in treatment. Further study is needed to better understand the mechanism of disease and ideal treatment strategy.
    No preview · Article · Jul 2014 · Journal of the American College of Cardiology

  • No preview · Article · Jun 2014 · Journal of Vascular Surgery
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    ABSTRACT: Patients with atriopulmonary Fontan tend to undergo conversion to total cavopulmonary connections secondary to arrhythmias or poor flow dynamics. However, the ideal candidate is unknown. Between December 1994 and May 2011, 70 patients (40 males [57%]) underwent Fontan conversion. Median age was 23 years (range, 4 to 46 years). Excluded were 1.5 ventricle conversions. The most common diagnoses included tricuspid atresia in 34patients (49%) and double-inlet left ventricle in 16 (23%). Atrial tachyarrhythmia was present in 62 patients (89%), 41 (59%) had atrioventricular valve (AVV) regurgitation, and 32 (46%) were in New York Heart Association class III or IV. Atriopulmonary Fontan was the original connection in 58 patients (83%), whereas the Björk modification was performed in 8 (11%). Fontan was performed with an intraatrial conduit in 41 patients, an extracardiac conduit in 18, and a lateral tunnel in 11. Forty-nine patients (70%) underwent concomitant arrhythmia operations. Early death occurred in 10 patients (14%). Multivariate analysis revealed age older than 27 years (p = 0.009), AVV regurgitation (p = 0.016), lack of arrhythmia operation (p = 0.04), and male sex (p = 0.02) were predictors of perioperative death. Mean follow-up was 5 years (maximum, 17 years). Overall survival at 1, 5, and 10 years was 81%, 70%, and 67%, respectively, and 84% of patients were in New York Heart Association class I or II. Proper selection of Fontan conversion candidates is critical. Concomitant arrhythmia operations may be associated with improved survival. Older age and AVV regurgitation increase the risk of poor outcome, and cardiac transplantation may be a better option.
    No preview · Article · Apr 2014 · The Annals of thoracic surgery
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    ABSTRACT: Objective To report our single-center experience with patients who had cardiac and multiorgan transplantation for end-stage congenital heart disease (CHD). Patients and Methods We reviewed records for all patients with CHD who had undergone heart transplantation at Mayo Clinic, Rochester, Minnesota, from November 1, 1990, through June 30, 2012. Patients with cardiomyopathy were excluded, unless CHD was present. Results Overall, 45 patients had cardiac transplantation for end-stage CHD (mean age, 26.1±18.4 years; range, 1 month to 65 years). Two patients (4%) had combined heart/liver transplantation; 1 (2%) had heart/kidney transplantation. Six patients (13%) had no previous cardiac operation; the remaining 39 patients had a mean of 3 (range, 1-8) previous cardiac operations. Patient survival (95% CI) at 1, 5, and 10 years was 89% (80%-98%), 89% (80%-98%), and 72% (56%-87%), respectively, while graft survival at 1, 5, and 10 years was 89% (80%-98%), 89% (80%-98%), and 61% (44%-78%), respectively. During the same era, the International Society for Heart & Lung Transplantation reported that survival in patients undergoing transplant for non-congenital diagnoses was 85%, 72%, and 56%, respectively. Over a mean follow-up of 8.7±6.2 years, rejection requiring treatment was documented in 35 patients (78%). Eleven patients (24%) have been diagnosed with neoplasia (8 skin, 1 blood, 1 lymph, and 1 other), and 3 patients (7%) have required retransplantation. Four patients (9%) have developed significant coronary vasculopathy; 1 successfully underwent retransplantation, and 3 died 6, 8, and 14 years after transplantation. Conclusion With appropriate patient selection and posttransplant monitoring, survival has improved for patients with complex end-stage CHD. Multiorgan transplantation is an option for selected patients with CHD.
    No preview · Article · Apr 2014 · Mayo Clinic Proceedings
  • Philip R Fischer · David J Driscoll · Ann M Reed · Christopher Moir

    No preview · Article · Mar 2014 · Mayo Clinic Proceedings
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    ABSTRACT: Sirolimus is used in heart transplant patients with CAV and CNI-induced nephropathy. However, little is known regarding the tolerability, rejection rate, and effect on renal function when used empirically in children. We describe our experience with the empiric use of a sirolimus-based immunosuppressive regimen in pediatric heart transplantation recipients. We reviewed records of patients in whom conversion was attempted to a CNI-free sirolimus-based regimen. Rejection episodes and measures of renal function were recorded. We attempted to convert 20 patients, of which 16 were successful. In total, six of 20 patients (30%) experienced adverse effects. Of the 16 converted, four patients converted to sirolimus due to CNI-induced disease (three nephropathy, one CAV), while 12 patients (mean age 5.5 yr, range 0.1-21 yr; 33% female; 33% with a history of congenital heart disease) were empirically switched to sirolimus at a mean of 2.3 yr after transplant. Follow-up was available for a mean of 2.5 yr after conversion (range 0.5-8.3 yr). The rate of rejection while taking CNIs was 0.18 rejection episodes per patient-year (total of five episodes), compared with 0.03 rejection episodes per patient-year (total of one episode) while on sirolimus. Renal function, in terms of GFR, significantly improved after sirolimus conversion at latest follow-up (from 86 ± 37 mL/min to 130 ± 49 mL/min, p = 0.02). Here, we demonstrate the potential benefit of empiric use of sirolimus in pediatric heart transplant patients in a CNI-free regimen. Larger and longer studies are needed to further clarify risks of rejection and adverse effect profiles.
    No preview · Article · Dec 2013 · Pediatric Transplantation

  • No preview · Article · Apr 2013 · The Journal of Heart and Lung Transplantation
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    ABSTRACT: Vascular malformations result from an arrest of development of a normal vascular structure or from abnormal growth of a vascular structure. Treatment continues to be a challenge. We sought to study the outcomes of sclerotherapy and embolization for vascular malformations. We reviewed clinical data of all patients treated with sclerotherapy or embolization for arteriovenous or venous malformations between 2006 and 2010 at Mayo Clinic. Follow-up information was obtained from clinical charts and a questionnaire sent to all patients. Overall, 60 patients (24 male and 36 female; mean age 31.7 years; range, 5.6 to 72.4 years) had 163 unique sclerotherapy or embolization procedures for lesions involving the lower extremity (55%), upper extremity (18.3%), pelvis (11.7%), abdomen (5%), chest (5%), back (3.3%), and multiple locations (1.7%). Thirty-one patients had low-flow venous malformations and 29 patients had high-flow arteriovenous malformations. Twenty-four patients required more than three sessions. The most common indication for intervention was pain (57 of 60 [95%]). Sixteen patients (27%) had documented or patient-reported complications. There was no significant difference in complication rates or lesion size between patients with low-flow or high-flow lesions. There were no procedural deaths. Mean available follow-up was 2.0 ± 1.3 years (range, 0.5 to 5.0 years). Median pain scores at most recent follow-up decreased significantly (P<.001). Eighty-three percent of the responders (24 of 29) would recommend treatment to others. With appropriate patient selection, sclerotherapy and embolization can decrease the pain of patients with arteriovenous and venous malformations. Multiple interventions might be necessary. Practitioners should be aware of the potential complications and counsel their patients about these risks.
    No preview · Article · Mar 2013 · Seminars in Vascular Surgery
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    ABSTRACT: Posterior reversible encephalopathy syndrome (PRES) is a disorder characterized by gray and white matter abnormalities in the temporal, parietal, and occipital lobes of the brain. Its etiology has been attributed to renal failure, immunosuppressive drugs such as cyclosporine and tacrolimus, and other potential entities leading to acute hypertension. Clinical findings include headaches, altered mental status, seizures, visual changes, and focal neurologic deficits. We report the case of a child who developed PRES with intracerebral and subarachnoid hemorrhages associated with tacrolimus exposure 10 days after heart transplantation for restrictive cardiomyopathy. The patient initially presented with complex partial seizures, headache, agitation, and hypertension. Head MRI was suggestive of PRES along with intracerebral and subarachnoid hemorrhages. Tacrolimus was discontinued and blood pressure was controlled. The patient's encephalopathy resolved, but he has had ongoing neurologic symptoms secondary to hemorrhage. Generally, PRES is less common in children than in the adult population and is a rare complication of calcineurin inhibitors (CNI). Presentation with secondary hemorrhage also can occur. In children receiving CNIs presenting with new neurologic symptoms, PRES should be considered as prompt discontinuation of the offending agent can induce resolution of symptoms. Children can develop hemorrhage in the context of PRES, leading to increased morbidity.
    No preview · Article · Jan 2013 · Pediatric Transplantation

Publication Stats

7k Citations
1,316.96 Total Impact Points

Institutions

  • 2015
    • Oklahoma State University - Tulsa
      Tulsa, Oklahoma, United States
  • 1984-2015
    • Mayo Clinic - Rochester
      • • Department of Pediatric and Adolescent Medicine
      • • Department of Cardiovascular Diseases
      • • Department of Internal Medicine
      Рочестер, Minnesota, United States
  • 2006-2009
    • Vascular and Interventional Radiology
      Chicago, Illinois, United States
  • 2000-2008
    • Mayo Foundation for Medical Education and Research
      • • Division of Vascular Surgery
      • • Division of Cardiovascular Diseases
      Рочестер, Michigan, United States
  • 1984-2005
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 1986
    • Medical University of South Carolina
      • Division of Pediatric Cardiology
      Charleston, South Carolina, United States