Heparin brand is associated with postsurgical outcomes in children undergoing cardiac surgery.

BACKGROUND: We sought to determine whether the use of specific unfractionated heparin brands during cardiopulmonary bypass for pediatric cardiac surgery was associated with differences in postoperative outcomes, especially regarding the incidence of bleeding and thromboembolic complications. METHODS: We compared postoperative outcomes for pediatric cardiac surgeries performed with Hepalean (Organon Teknika) to those performed with PPC heparin (Pharmaceutical Partners of Canada). Differences in clinical outcomes were determined in multivariable logistic and linear regression models adjusted for patients and surgery characteristics. RESULTS: In all, 903 operations were reviewed, 289 (32%) using Hepalean and 614 (68%) using PPC heparin. Patient demographics and surgical variables were comparable between groups. In multivariable regression models, adjusted for patients' characteristics, heparin use and choice of antifibrinolytic agents, the use of PPC heparin was associated with greater use of red blood cell transfusions in the first 48 postoperative hours (estimates +1.6 mL/kg, p<0.001), increased odds of bleeding complications (odds ratio 3.8, p=0.04), thromboembolic complications (odds ratio 4.7, p=0.01), early unplanned reoperation (odds ratio 6.9, p=0.03), longer postoperative intensive care unit stay (estimate +3.2 days, p<0.001), and longer hospital stay (estimate +3.6 days, p<0.001). CONCLUSIONS: Brand of unfractionated heparin used during cardiopulmonary bypass for pediatric cardiac surgery was associated with bleeding complications and clinical outcomes. Different brands of unfractionated heparin should not be considered equivalent without proper validation in formal trials.

Feasibility of very-high resolution ultrasound to assess elastic and muscular arterial wall morphology in adolescents attending an outpatient clinic for obesity and lipid abnormalities.

OBJECTIVE: Atherosclerosis begins during early life and is accelerated in individuals with cardiovascular risk factors. We hypothesized that very-high resolution ultrasound (VHRU, 25-55 MHz) could feasibly detect early arterial changes in adolescents with risk factors. METHODS: We prospectively imaged the carotid, brachial and radial arterial morphology (far wall intima-media thickness, IMT; adventitia thickness, AT) by VHRU in 58 youths (age 14 ± 2 years) attending a Pediatric Preventive Cardiology Clinic for assessment and management of cardiovascular risk factors and compared the findings to those from an age-matched group of 67 controls. RESULTS: Brachial and radial imaging was successful for all subjects. The carotid far wall could not be imaged in 7% of the patients due to limitations in penetration. VHRU image quality was related to body size and imaging depth. Imaging and analysis time were 12 ± 3 and 18 ± 3 min, respectively. Carotid IMT was increased in patients (0.42 ± 0.05 vs. 0.40 ± 0.06 mm, p = 0.05). No differences were found in brachial or radial IMT or AT vs. controls. Age, male gender, body mass index, systolic blood pressure (BP), but not lipid levels, were associated with arterial IMT in regression analyses. CONCLUSION: VHRU is feasible in imaging carotid and peripheral muscular artery IMT in adolescents. The arterial IMT is associated with age, gender, adiposity and systolic BP, but not lipid levels, in this adolescent population. Further studies including patients with manifest clinical atherosclerosis are needed to assess if VHRU has applications in atherosclerosis research.

The 'Golden Keys' to health - a healthy lifestyle intervention with randomized individual mentorship for overweight and obesity in adolescents.

OBJECTIVE: To conduct a pilot study designed to measure the impact of a healthy lifestyle intervention with or without individualized mentorship on adiposity, metabolic profile, nutrition and physical activity in overweight teens. METHODS: A total of 38 overweight adolescents (body mass index above the 85th percentile) 12 to 16 years of age, who were enrolled in a healthy lifestyle intervention program for six months, were randomly assigned to a nonmentored or individualized mentored intervention. RESULTS: For the entire cohort (final n=32), there was a nonstatistically significant reduction in mean (± SD) body mass index z score (2.08±0.38 to 2.01±0.47, P=0.07) and waist circumference (98±10 cm to 96±11 cm, P=0.08), and significant improvements in high-density lipoprotein level (1.08±0.24 mmol/L to 1.20±0.26 mmol/L, P<0.001), and low-density lipoprotein/high-density lipoprotein ratio (2.55±0.84 to 2.26±0.87, P<0.001) from baseline to the end of the intervention. Subjects consumed fewer high-calorie foods (3.9±1.9 to 3.0±1.5 servings/day, P=0.01) and snacks (9.7±5.5 to 6.8±4.0 servings/day, P=0.02), made fewer fast food restaurant visits (1.4±1.3 to 0.8±0.9 visits/week, P=0.02), and had less screen time (8.3±3.8 to 6.9±3.6 h/day, P=0.01). In addition, mentorship was found to be a feasible approach to supporting weight management in obese teens. Our study was underpowered to determine treatment effect, but promising modifications to lifestyle were observed despite the absence of statistically significant improvements in outcomes. CONCLUSIONS: The healthy lifestyle intervention improved subjects' lifestyles and lipid profiles, and the addition of mentorship in this context is feasible. A larger study with a longer intervention time is required to determine whether behavioural changes are associated with clinical improvement and to determine the role of mentorship in promoting lifestyle change.