Scholars@Duke
Brian Clark

Selected Publications

The effects of pulsatile versus nonpulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous microemboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery

Conference JTCVS Open · December 1, 2023 Objective: The objective of this retrospective review was to evaluate whether or not pulsatile flow improves cerebral hemodynamics and clinical outcomes in pediatric congenital cardiac surgery patients. Methods: This retrospective study included 284 pediat ... Full text Cite

Use of aortic wall patches as leaflet replacement material during aortic valve repair

Conference JTCVS Techniques · June 1, 2023 Objectives: Aortic valve repair can be limited by inadequate leaflet tissue for proper coaptation. Various kinds of pericardium have been used for cusp augmentation, but most have failed because of tissue degeneration. A more durable leaflet substitute is ... Full text Cite

Successful application of the innovation process to a case of Floyd Type I tracheal agenesis

Journal Article Surgery Open Science · January 1, 2023 Background: Innovation is broadly defined as the act of introducing a new product, idea, or process. The field of surgery is built upon innovation, revolutionizing technology, science, and tools to improve patient care. While most innovative solutions are ... Full text Cite

Direct ventriculoatrial shunt in a pediatric patient: case report and technical note.

Journal Article Childs Nerv Syst · January 2023 BACKGROUND /IMPORTANCE: The safety of direct cardiac shunts has been historically described in the pediatric population before the introduction of silastic catheters but are rarely utilized in modern practice. Herein, we describe several technical nuances ... Full text Link to item Cite

Safety and utility of modified ultrafiltration in pediatric cardiac surgery.

Journal Article Perfusion · January 2023 INTRODUCTION: Modified ultrafiltration (MUF) is employed at the termination of cardiopulmonary bypass (CPB) in pediatric and neonatal patients undergoing congenital heart surgery to reduce the accumulation of total body water thus increasing the concentrat ... Full text Link to item Cite

A Randomized Clinical Trial of Perfusion Modalities in Pediatric Congenital Heart Surgery Patients.

Conference Ann Thorac Surg · October 2022 BACKGROUND: The objective of this randomized clinical trial was to investigate the effects of perfusion modalities on cerebral hemodynamics, vital organ injury, quantified by the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score, and clinical outcomes ... Full text Link to item Cite

Discussion

Journal Article JTCVS Open · March 1, 2022 Full text Cite

Electrocardiogram-synchronized pulsatility for ECMO

Chapter · January 1, 2022 Despite substantial advances in current extracorporeal life support (ECLS) technology, mechanical complications within the circuit and complications involving vital organs account for most of the mortality in patients undergoing ECLS for cardiac complicati ... Full text Cite

A model for a standardized and sustainable pediatric anesthesia-intensive care unit hand-off process

Journal Article Children · September 1, 2020 Background and Objectives: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives ... Full text Cite

The Penn State Pediatric Total Artificial Heart

Chapter · January 1, 2020 There is an unmet need for total circulatory support in infants on the waiting list for heart transplantation. Congenital defects and pulmonary dysfunction often require right heart support in addition to systemic support. Penn State is developing a pediat ... Full text Cite

Clinical outcomes of neonatal and pediatric extracorporeal life support: A seventeen-year, single institution experience.

Journal Article Artif Organs · November 2019 The objective of this study was to describe a single-center experience with neonatal and pediatric extracorporeal life support (ECLS) and compare patient-related outcomes with those of the Extracorporeal Life Support Organization (ELSO) Registry. A retrosp ... Full text Link to item Cite

Chronic In Vivo Test of a Right Heart Replacement Blood Pump for Failed Fontan Circulation.

Journal Article ASAIO J · August 2019 An implantable rotary blood pump was developed to provide long-term mechanical right heart support for patients who have failing Fontan circulation. The objective of this study was to evaluate the pump in vivo in a 30 day sheep study. Pump speed was set at ... Full text Link to item Cite

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Neonate with Turner Syndrome and Aortic Arch Hypoplasia.

Journal Article Tex Heart Inst J · June 2019 Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicus ... Full text Open Access Link to item Cite

Trisomy 18 and Congenital Heart Disease: Single-Center Review of Outcomes and Parental Perspectives.

Journal Article World J Pediatr Congenit Heart Surg · September 2018 BACKGROUND: In patients with trisomy 18, congenital heart surgery is controversial due to anticipated poor patient outcome. Data are lacking regarding clinical outcomes and family opinions about care received. METHODS: A retrospective chart review of patie ... Full text Link to item Cite

Impact of Different Perfusion Modalities on Coronary and Carotid Blood Flow Velocities in an Adult ECLS Swine Model.

Journal Article Artif Organs · September 2018 The objective of this study was to compare the effects of nonpulsatile and ECG-synchronized pulsatile extracorporeal life support on coronary and carotid blood flow velocities using transthoracic echocardiography and vascular ultrasound, respectively. Nine ... Full text Link to item Cite

Pulmonary valve restitution following transannular patch repair of tetralogy of Fallot.

Journal Article Interact Cardiovasc Thorac Surg · December 1, 2017 Chronic pulmonary insufficiency following transannular patch repair of tetralogy of Fallot may mandate restoration of a competent pulmonary valve. Pulmonary valve leaflets that are preserved at initial surgery may grow and develop normal morphology and sub ... Full text Link to item Cite

Complete Atrioventricular Canal Defect: Influence of Timing of Repair on Intermediate Outcomes

Journal Article World Journal for Pediatric and Congenital Heart Surgery · May 1, 2017 Background: The optimal timing of repair of complete atrioventricular canal defect (CAVC) remains uncertain. When early repair is indicated due to clinical conditions, patients may be potentially exposed to excess morbidity or mortality. We reviewed our ex ... Full text Cite

Invited Commentary.

Journal Article Ann Thorac Surg · April 2017 Full text Link to item Cite

Penetrating Cardiac Nail Gun Injury in a Child.

Journal Article Pediatr Emerg Care · August 2016 Nail gun injuries primarily occur in the extremities of adult males as a consequence of accidental occupational trauma. Such injury involving the thorax is much less common, and penetrating cardiac injury secondary to pneumatic nail gun discharge is rare. ... Full text Link to item Cite

In Vivo Hemodynamic Performance Evaluation of Novel Electrocardiogram-Synchronized Pulsatile and Nonpulsatile Extracorporeal Life Support Systems in an Adult Swine Model.

Journal Article Artif Organs · July 2015 The primary objective of this study was to evaluate a novel electrocardiogram (ECG)-synchronized pulsatile extracorporeal life support (ECLS) system for adult partial mechanical circulatory support for adequate quality of pulsatility and enhanced hemodynam ... Full text Link to item Cite

Early outcomes of pulmonary valve replacement with the mitroflow bovine pericardial bioprosthesis.

Conference Ann Thorac Surg · May 2015 BACKGROUND: Bovine pericardial valves are often used for pulmonary valve replacement (PVR) in patients with previously repaired congenital heart disease. Attention has recently focused on the safety of the Mitroflow (Sorin Group USA, Arvada, CO) bovine per ... Full text Link to item Cite

In vitro hemodynamic evaluation of a novel pulsatile extracorporeal life support system: impact of perfusion modes and circuit components on energy loss.

Journal Article Artif Organs · January 2015 The objective of this study is to investigate the impact of every component of extracorporeal life support (ECLS) circuit on hemodynamic energy transmission in terms of energy equivalent pressure (EEP), total hemodynamic energy (THE), and surplus hemodynam ... Full text Link to item Cite

Apolipoprotein E levels in pediatric patients undergoing cardiopulmonary bypass.

Journal Article Artif Organs · January 2015 Apolipoprotein E (apoE) may play a critical role in modulating the response to neurological injury after cardiopulmonary bypass (CPB) in children. Plasma samples were collected from 38 pediatric patients. Half of the patients received nonpulsatile flow and ... Full text Link to item Cite

Evaluation of a novel pulsatile extracorporeal life support system synchronized to the cardiac cycle: effect of rhythm changes on hemodynamic performance.

Journal Article Artif Organs · January 2015 Arrhythmias are a frequent complication during extracorporeal life support (ECLS). A new ECLS system can provide pulsatile flow synchronized to the patient's intrinsic cardiac cycle based upon the R wave of the electrocardiogram (ECG). It is unclear how th ... Full text Link to item Cite

The impact of cerebral embolization during infant cardiac surgery on neurodevelopmental outcomes at intermediate follow-up.

Journal Article Perfusion · September 2014 Cerebral embolization during pediatric cardiac surgery may be an underappreciated source of subsequent neurodevelopmental impairment. Transcranial Doppler ultrasound is a neuromonitoring tool that can provide intraoperative surveillance for cerebral emboli ... Full text Link to item Cite

Resection of a Giant Left Atrial Appendage Aneurysm via Limited Thoracotomy.

Journal Article World J Pediatr Congenit Heart Surg · July 2014 A left atrial appendage aneurysm is a rare cause of atrial arrhythmia in a young adult. Resection of the aneurysm is uniformly recommended in order to prevent thromboembolism and stroke. In patients without evidence of clot within the aneurysm, operative r ... Full text Link to item Cite

Comparative effects of pulsatile and nonpulsatile flow on plasma fibrinolytic balance in pediatric patients undergoing cardiopulmonary bypass.

Journal Article Artif Organs · January 2014 In the brain, the components of the fibrinolytic system, tissue plasminogen activator (tPA) and its endogenous inhibitor plasminogen activator inhibitor-1 (PAI-1), regulate various neurophysiological and pathological responses. Fibrinolytic balance depends ... Full text Link to item Cite

Occult coronary ostial obstruction late after arterial switch operation.

Journal Article J Card Surg · May 2013 Occult coronary artery obstruction can be a late source of morbidity and mortality following the arterial switch operation for transposition of the great arteries. We describe a case of undiagnosed left coronary ostial obstruction in a teenager which may h ... Full text Link to item Cite

Long-term results of the subclavian flap repair for coarctation of the aorta in infants.

Journal Article World J Pediatr Congenit Heart Surg · January 2013 BACKGROUND: Coarctation is a congenital narrowing of the aorta that often requires repair during infancy. The subclavian flap aortoplasty was once widely favored for its avoidance of a circumferential suture line and low incidence of recoarctation. The aim ... Full text Link to item Cite

Exercise stress echocardiography after childhood Ross surgery: functional outcome in 26 patients from a single institution.

Journal Article Pediatr Cardiol · June 2012 Adult studies suggest a better functional outcome after aortic valve replacement with a pulmonary autograft compared with mechanical or homograft valves. Little is known about functional results after Ross surgery in growing children. This study reports fo ... Full text Link to item Cite

Multimodality Neuromonitoring for Pediatric Cardiac Surgery: Our Approach and a Critical Appraisal of the Available Evidence

Journal Article World Journal for Pediatric and Congenital Heart Surgery · January 1, 2012 Brain injury remains a source of morbidity associated with congenital heart surgery. Intraoperative neuromonitoring is used by many centers to help minimize neurologic injury and improve outcomes. Neuromonitoring at our institution is performed using a com ... Full text Cite

Chronic in vivo testing of the Penn State infant ventricular assist device.

Journal Article ASAIO J · 2012 The Penn State Infant Ventricular Assist Device (VAD) is a 12-14 ml stroke volume pneumatically actuated pump, with custom Björk-Shiley monostrut valves, developed under the National Heart, Lung, and Blood Institute Pediatric Circulatory Support program. I ... Full text Open Access Link to item Cite

The kinetics of cardiopulmonary bypass: a dual-platform proteomics study of plasma biomarkers in pediatric patients undergoing cardiopulmonary bypass.

Journal Article Artif Organs · January 2012 This study was designed to investigate the expression kinetics and patterns of plasma biomarkers throughout the pediatric cardiopulmonary bypass (CPB) procedure to help predict those patients most at risk for complications. This study sampled plasma from p ... Full text Link to item Cite

Benefits of pulsatile flow in pediatric cardiopulmonary bypass procedures: from conception to conduction.

Journal Article Perfusion · September 2011 This review on the benefits of pulsatile flow includes not only experimental and clinical data, but also attempts to further illuminate the major factors as to why this debate has continued during the past 55 years. Every single component of the cardiopulm ... Full text Link to item Cite

Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass.

Journal Article Pediatr Res · August 2011 Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpuls ... Full text Link to item Cite

Hemodynamic evaluation of arterial and venous cannulae performance in a simulated neonatal extracorporeal life support circuit.

Journal Article Perfusion · July 2011 OBJECTIVE: To construct an ideal extracorporeal life support (ECLS) circuit in terms of hemodynamic performance, each component of the circuit should be evaluated. Most cannulae manufacturers evaluate their products using water as the priming solution. We ... Full text Link to item Cite

Mechanical circulatory support for end-stage heart failure in repaired and palliated congenital heart disease.

Journal Article Curr Cardiol Rev · May 2011 Approximately one in one hundred children is born with congenital heart disease. Most can be managed with corrective or palliative surgery but a small group will develop severe heart failure, leaving cardiac transplantation as the ultimate treatment option ... Full text Open Access Link to item Cite

An investigational study of minimum rotational pump speed to avoid retrograde flow in three centrifugal blood pumps in a pediatric extracorporeal life support model.

Journal Article Perfusion · May 2011 During extracorporeal life support with centrifugal blood pumps, retrograde pump flow may occur when the pump revolutions decrease below a critical value determined by the circuit resistance and the characteristics of the pump. We created a laboratory mode ... Full text Link to item Cite

Microemboli Detection and Classification During Pediatric Cardiopulmonary Bypass

Journal Article World Journal for Pediatric and Congenital Heart Surgery · January 1, 2011 Microemboli may be a cause of postoperative neurological morbidity. Improved detection of microemboli may lead to better strategies to minimize embolization and improve neurological outcomes. Transcranial Doppler may have limited sensitivity for very small ... Full text Cite

Discussion

Journal Article Annals of Thoracic Surgery · January 1, 2011 Full text Cite

Pediatric extracorporeal life support systems: education and training at Penn State Hershey Children's Hospital.

Journal Article Artif Organs · November 2010 The following is a description of the training offered to extracorporeal life support (ECLS)-trained staff at the Penn State Hershey Children’s Hospital. Changes with the ECLS circuit prompted the need for an initiative to train staff in the care of patien ... Full text Link to item Cite

Inflammatory and hemostatic response to cardiopulmonary bypass in pediatric population: feasibility of seriological testing of multiple biomarkers.

Journal Article Artif Organs · November 2010 Perioperative myocardial and cerebral damages are the major determinants of postoperative morbidity and mortality in pediatric cardiac surgery. Cardiopulmonary bypass (CPB) causes alterations in the levels of biomarkers related to inflammation, tissue dama ... Full text Link to item Cite

Impact of tubing length on hemodynamics in a simulated neonatal extracorporeal life support circuit.

Journal Article Artif Organs · November 2010 During extracorporeal life support (ECLS), a large portion of the hemodynamic energy is lost to various components of the circuit. Minimization of this loss in the circuit leads to better vital organ perfusion and decreases the risk of systemic inflammatio ... Full text Link to item Cite

Dual-platform proteomics study of plasma biomarkers in pediatric patients undergoing cardiopulmonary bypass.

Journal Article Pediatr Res · June 2010 Plasma samples from pediatric cardiac patients undergoing cardiopulmonary bypass (CPB) procedures were used to identify and characterize patterns of changes in potential biomarkers related to tissue damage and inflammation. These included proteins associat ... Full text Link to item Cite

Resolution of heart block after surgical removal of an amplatzer device.

Journal Article Ann Thorac Surg · May 2010 A large secundum atrial septal defect in a 4-year-old child was closed by percutaneous placement of an Amplatzer septal occluder (AGA Medical Corporation, Plymouth, MN). After device placement, complete heart block developed that did not resolve after 3 da ... Full text Link to item Cite

Segmental differences of impaired diastolic relaxation following cardiopulmonary bypass surgery in children: a tissue Doppler study.

Journal Article Artif Organs · November 2009 Impaired myocardial relaxation is an important aftereffect of cardiopulmonary bypass (CPB). Infants with their immature calcium metabolism may be particularly vulnerable. However, it has been difficult to quantitate diastolic dysfunction clinically. This s ... Full text Link to item Cite

Clinical real-time monitoring of gaseous microemboli in pediatric cardiopulmonary bypass.

Journal Article Artif Organs · November 2009 We describe the occurrence and distribution of gaseous microemboli with real-time monitoring in a pediatric cardiopulmonary bypass (CPB) circuit and in the cerebral circulation of patients using the Emboli Detection and Classification (EDAC) system and tra ... Full text Link to item Cite

Animal model development for the Penn State pediatric ventricular assist device.

Journal Article Artif Organs · November 2009 In March 2004, the National Heart, Lung, and Blood Institute awarded five contracts to develop devices providing circulatory support for infants and small children with congenital and acquired cardiac disease. Since 2004, the team at Penn State College of ... Full text Link to item Cite

Intraoperative techniques to assess cardiac function-feasiblity of strain rate imaging in the perioperative period in children.

Conference ASAIO J · 2008 The noninvasive assessment of cardiac function during mechanical circulatory support is challenging because conventional markers (like ejection fraction) are significantly load-dependent. Yet loading conditions are abnormal and change during support and we ... Full text Link to item Cite