On 2015 Jan 09, William Grant commented:

Differences in vitamin D status may help explain racial disparities in failure-to-rescue among children undergoing congenital heart surgery

The paper by Chan and colleagues did a comprehensive analysis of outcomes of pediatric congenital heart surgery, finding that failure-to-rescue was due to inherent racial factors rather than complications related to the surgery, with blacks having the worst outcome and Hispanics intermediate between blacks and whites [1]. A possible explanation for this finding is differences in 25-hydroxyvitamin D [25(OH)D] concentrations. A paper from 2004 reported that cardiac failure in infancy due to vitamin D deficiency in two infants who avoided surgery through vitamin D and calcium therapy [2]. A recent paper noted that 84% of African-American neonates undergoing cardiac operations had vitamin D deficiency (25(OH)D <20 ng/mL) and had a mean pre-operation 25(OH)D concentration of 10±4 ng/mL compared to 16± ng/mL for Caucasians and other race/ethnicity [3]. Those with lower 25(OH)D concentrations required greater post-operation care. Another recent study found that 25(OH)D concentrations decreased by 40% in infants and children after surgery for congenital heart disease [4].

In general, white Americans have the highest mean 25(OH)D concentrations, Hispanics somewhat lower, and black Americans the lowest concentrations [5]. The differences are due to differences in skin pigmentation since most vitamin D is produced from solar UVB exposure, and the darker the skin, the lower the efficiency in producing vitamin D. Disparities in various health outcomes have been attributed to these differences [6].

While it may be difficult to obtain blood samples from those who were included in this study for measurement of 25(OH)D concentrations, that could be done for planned operations in the future. In the meantime, it would be worthwhile to consider making sure that all children planning congenital heart surgery first be supplemented with vitamin D to raise 25(OH)D concentrations to 30-40 ng/mL [7] with a daily dose depending on how rapidly it is desired to raise the concentrations [8]. It would be worthwhile to see whether the heart condition improved before scheduling the operation. Since post-operation infection such as sepsis occurs in about 3.7% of operations in the U.S. [9], and vitamin D reduces the risk of sepsis [10], reducing the risk of sepsis is another good reason to raise 25(OH)D concentrations prior to operating.

References 1. Chan T, Lion KC, Mangione-Smith R. Racial disparities in failure-to-rescue among children undergoing congenital heart surgery. J Pediatr. 2014 Dec 30. pii: S0022-3476(14)01072-5. doi: 10.1016/j.jpeds.2014.11.020. [Epub ahead of print] 2. Carlton-Conway D, Tulloh R, Wood L, Kanabar D. Vitamin D deficiency and cardiac failure in infancy. J R Soc Med. 2004;97(5):238-9. 3. Graham EM, Taylor SN, Zyblewski SC, et al. Vitamin D status in neonates undergoing cardiac operations: relationship to cardiopulmonary bypass and association with outcomes. J Pediatr. 2013;162(4):823-6. 4. McNally JD, Menon K, Chakraborty P, et al. Impact of anesthesia and surgery for congenital heart disease on the vitamin d status of infants and children: a prospective longitudinal study. Anesthesiology. 2013;119(1):71-80. 5. Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009;169(6):626-32. 6. Grant WB, Peiris AN. Possible role of serum 25-hydroxyvitamin D in Black–White health disparities in the United States. J Am Med Directors Assoc. 2010;11(9):617-28. 7. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2011;96(7):1911-30. 8. Heaney RP, Davies KM, Chen TC, et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77(1):204-10. 9. Pasquali SK, He X, Jacobs ML, et al. Hospital variation in postoperative infection and outcome after congenital heart surgery. Ann Thorac Surg. 2013;96(2):657-63. 10. de Haan K, Groeneveld A, de Geus H, et al. Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit Care. 2014;18(6):660. [Epub ahead of print]

Disclosure I receive funding from Bio-Tech Pharmacal (Fayetteville, AR) and MediSun Technology (Highland Park, IL).

On 2015 Jan 09, William Grant commented:

Differences in vitamin D status may help explain racial disparities in failure-to-rescue among children undergoing congenital heart surgery

The paper by Chan and colleagues did a comprehensive analysis of outcomes of pediatric congenital heart surgery, finding that failure-to-rescue was due to inherent racial factors rather than complications related to the surgery, with blacks having the worst outcome and Hispanics intermediate between blacks and whites [1]. A possible explanation for this finding is differences in 25-hydroxyvitamin D [25(OH)D] concentrations. A paper from 2004 reported that cardiac failure in infancy due to vitamin D deficiency in two infants who avoided surgery through vitamin D and calcium therapy [2]. A recent paper noted that 84% of African-American neonates undergoing cardiac operations had vitamin D deficiency (25(OH)D <20 ng/mL) and had a mean pre-operation 25(OH)D concentration of 10±4 ng/mL compared to 16± ng/mL for Caucasians and other race/ethnicity [3]. Those with lower 25(OH)D concentrations required greater post-operation care. Another recent study found that 25(OH)D concentrations decreased by 40% in infants and children after surgery for congenital heart disease [4].

In general, white Americans have the highest mean 25(OH)D concentrations, Hispanics somewhat lower, and black Americans the lowest concentrations [5]. The differences are due to differences in skin pigmentation since most vitamin D is produced from solar UVB exposure, and the darker the skin, the lower the efficiency in producing vitamin D. Disparities in various health outcomes have been attributed to these differences [6].

While it may be difficult to obtain blood samples from those who were included in this study for measurement of 25(OH)D concentrations, that could be done for planned operations in the future. In the meantime, it would be worthwhile to consider making sure that all children planning congenital heart surgery first be supplemented with vitamin D to raise 25(OH)D concentrations to 30-40 ng/mL [7] with a daily dose depending on how rapidly it is desired to raise the concentrations [8]. It would be worthwhile to see whether the heart condition improved before scheduling the operation. Since post-operation infection such as sepsis occurs in about 3.7% of operations in the U.S. [9], and vitamin D reduces the risk of sepsis [10], reducing the risk of sepsis is another good reason to raise 25(OH)D concentrations prior to operating.

References 1. Chan T, Lion KC, Mangione-Smith R. Racial disparities in failure-to-rescue among children undergoing congenital heart surgery. J Pediatr. 2014 Dec 30. pii: S0022-3476(14)01072-5. doi: 10.1016/j.jpeds.2014.11.020. [Epub ahead of print] 2. Carlton-Conway D, Tulloh R, Wood L, Kanabar D. Vitamin D deficiency and cardiac failure in infancy. J R Soc Med. 2004;97(5):238-9. 3. Graham EM, Taylor SN, Zyblewski SC, et al. Vitamin D status in neonates undergoing cardiac operations: relationship to cardiopulmonary bypass and association with outcomes. J Pediatr. 2013;162(4):823-6. 4. McNally JD, Menon K, Chakraborty P, et al. Impact of anesthesia and surgery for congenital heart disease on the vitamin d status of infants and children: a prospective longitudinal study. Anesthesiology. 2013;119(1):71-80. 5. Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009;169(6):626-32. 6. Grant WB, Peiris AN. Possible role of serum 25-hydroxyvitamin D in Black–White health disparities in the United States. J Am Med Directors Assoc. 2010;11(9):617-28. 7. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2011;96(7):1911-30. 8. Heaney RP, Davies KM, Chen TC, et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77(1):204-10. 9. Pasquali SK, He X, Jacobs ML, et al. Hospital variation in postoperative infection and outcome after congenital heart surgery. Ann Thorac Surg. 2013;96(2):657-63. 10. de Haan K, Groeneveld A, de Geus H, et al. Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit Care. 2014;18(6):660. [Epub ahead of print]

Disclosure I receive funding from Bio-Tech Pharmacal (Fayetteville, AR) and MediSun Technology (Highland Park, IL).