Author + information
- Melissa Yamauchia,b,
- Michael Puchalskia,b,
- Nelangi Pintoa,b,
- Susan Etheridgea,b,
- Hsin-Yi Wenga,b,
- Angela Pressona,b,
- L. LuAnn Minicha,b and
- Richard Williamsa,b
Background: The AHA/ACC Task Force 7 recommends competitive sport restrictions (CSR) for patients with an isolated bicuspid aortic valve (BAV) and dilated aorta (z-score >2). We analyzed practice variation in CSR for children with BAV and factors influencing recommendations.
Methods: This retrospective single-center cohort study included children (<18 years) with an isolated BAV diagnosed from 01/05 to 12/14. CSR, follow-up interval, aortic stenosis (AS) and aortic regurgitation (AR) severity, aortic root and ascending aorta z-scores and outcomes were collected. Descriptive statistics and multi-variable mixed-effect logistic regression models were performed with providers and subjects as random effects. Adjusted odds ratio (OR) and 95% confidence interval (CI) were reported. Percent provider variation was estimated using the intra-class correlation coefficient.
Results: In 1,300 encounters (423 children; 28 providers), no CSR were documented in 25%, including 24% of encounters with a dilated (z-score >2) aortic root and 18% of encounters with a dilated ascending aorta, while 38% of encounters with a dilated aortic root and 40% of encounters with a dilated ascending aorta had high-static or high-dynamic CSR. There were no ≤ moderate static or dynamic CSR. Provider contributed 36% of observed CSR practice variation (p<0.001). CSR were independently associated with older age (OR 1.3, 95% CI 1.2-1.4), higher ascending aorta z-score (OR 1.5, 95% CI 1.2-1.8), and shorter follow-up interval (OR 0.5, 95% CI 0.4-0.7). CSR were not associated with aortic root z-score, AS or AR severity. There were no aortic dissections or deaths, and 1 cardiac intervention (BAV repair and aortic root replacement).
Conclusions: Physicians frequently fail to document CSR for children with BAV and when documented, vary from guidelines. A significant proportion of the variation in exercise restrictions is directly attributable to the provider rather than disease severity. Despite the variation in CSR, few adverse outcomes occurred in this cohort. Further study to understand deviation from recommended guidelines and the effect of CSR on BAV outcomes may lead to evidence based guidelines that are more widely accepted.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1182-020
- 2017 American College of Cardiology Foundation