This proposal describes a five-year training program for development of a career in clinical research focusing on outcomes in tetralogy of Fallot (TOF), the most common form of cyanotic congenital heart defect. The candidate is an under-represented minority with training in pediatric cardiology and epidemiology. The goals of this award are to rigorously conduct this research proposal, to use the training obtained to develop into a mentor to other under-represented minority and, ultimately, to use this award as a vehicle to become a federally funded independent investigator. To achieve these goals, the applicant has set up a training plan that will include mentoring, course work, hands-on conduct of research and didactic educational activities. This project will be carried out under the mentorship of Steven Kawut, MD, MSCE, a leader in pulmonary hypertension and in the study of the right ventricle. Dr. Kawut is a tenured Associate Professor of Medicine and Epidemiology. He has successfully mentored fellows and junior faculty and holds a K24 to support his mentoring endeavors. An advisory committee has been assembled to help guide the candidate's career development. This application focuses on two main questions related to TOF. First, surgical repair (mandatory in TOF) is electively performed in the first few months of life to avoid cardiac surgery in the neonatal period. However, the severely cyanotic patient that requires intervention in the neonatal period (first month of life) can undergo either a complete surgical repair or a staged repair. The staged repair consists of a neonatal palliative procedure followed by complete repair in subsequent months. Each approach has advantages and disadvantages, and the choice is center-dependent and highly debated. We propose to address this debate by conducting a retrospective cohort study using data from 42 children's hospitals to examine the outcome associated with the two approaches. This comparative effectiveness study will provide generalizable results in a real life population using a highly feasible design that will inform a future trial and will ultimately benefit patients. Second, the right ventricle (RV) in TOF remodel (changes in size, geometry and function) after surgery in response to surgery itself and from residual lesions resulting from the repair. The clinical response to the RV remodeling is quite variable and the determining mechanisms are poorly understood. We hypothesize that early perioperative RV remodeling represents a critical time period that has a significant impact on the phenotypical variability in TOF. We propose a prospective cohort study of TOF patients to detect adverse RV remodeling in the post-operative period with sensitive imaging markers and circulating biomarkers. We will establish the impact of surgical procedure and early pathophysiologic mechanisms of RV remodeling on clinical outcomes and set up future studies that will eventually lead to improved outcomes in children with TOF.

Public Health Relevance

Tetralogy of Fallot is one of the most common forms of congenital heart defects and requires surgical repair. The early events associated with the surgical repair might determine short and long-term outcomes. The mechanisms underlying such evens have not been completely established and constitute the focus of this proposal.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01HL125521-05
Application #
9609470
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Meadows, Tawanna
Project Start
2014-12-01
Project End
2019-11-30
Budget Start
2018-12-01
Budget End
2019-11-30
Support Year
5
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Children's Hospital of Philadelphia
Department
Type
DUNS #
073757627
City
Philadelphia
State
PA
Country
United States
Zip Code
19146
Himebauch, Adam S; Yehya, Nadir; Wang, Yan et al. (2018) Early Right Ventricular Systolic Dysfunction and Pulmonary Hypertension Are Associated With Worse Outcomes in Pediatric Acute Respiratory Distress Syndrome. Crit Care Med 46:e1055-e1062
Bhatt, Shivani M; Elci, Okan U; Wang, Yan et al. (2018) Determinants of Exercise Performance in Children and Adolescents with Repaired Tetralogy of Fallot Using Stress Echocardiography. Pediatr Cardiol :
Mercer-Rosa, Laura; Elci, Okan U; Pinto, Nelangi M et al. (2018) 22q11.2 Deletion Status and Perioperative Outcomes for Tetralogy of Fallot with Pulmonary Atresia and Multiple Aortopulmonary Collateral Vessels. Pediatr Cardiol 39:906-910
DiLorenzo, Michael P; Elci, Okan U; Wang, Yan et al. (2018) Longitudinal Changes in Right Ventricular Function in Tetralogy of Fallot in the Initial Years after Surgical Repair. J Am Soc Echocardiogr 31:816-821
Savla, Jill J; Fisher, Brian T; Faerber, Jennifer A et al. (2018) Complete Versus Staged Repair for Neonates With Tetralogy of Fallot: Establishment and Validation of a Cohort of 2235 Patients Using Detailed Surgery Sequence Review of Health Care Administrative Data. Med Care 56:e76-e82
DiLorenzo, Michael P; Santo, Ashley; Rome, Jonathan J et al. (2018) Pulmonary Vein Stenosis: Outcomes in Children with Congenital Heart Disease and Prematurity. Semin Thorac Cardiovasc Surg :
DiLorenzo, Michael P; Goldmuntz, Elizabeth; Nicolson, Susan C et al. (2018) Early postoperative remodelling following repair of tetralogy of Fallot utilising unsedated cardiac magnetic resonance: a pilot study. Cardiol Young 28:697-701
DiLorenzo, Michael; Hwang, Wei-Ting; Goldmuntz, Elizabeth et al. (2018) Diastolic dysfunction in tetralogy of Fallot: Comparison of echocardiography with catheterization. Echocardiography 35:1641-1648
Mercer-Rosa, Laura; Goldberg, David J (2018) Prognostic Value of Serial Echocardiography in Hypoplastic Left Heart Syndrome: Smaller Hearts, Better Results. Circ Cardiovasc Imaging 11:e008006
Mercer-Rosa, Laura; Zhang, Xuemei; Tanel, Ronn E et al. (2018) Perioperative Factors Influence the Long-Term Outcomes of Children and Adolescents with Repaired Tetralogy of Fallot. Pediatr Cardiol :

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