World journal for pediatric & congenital heart surgery最新文献

We present a simple technique to decrease Gore-Tex needle hole bleeding during pediatric cardiac surgery. Use of this technique will potentially decrease blood loss, and blood product transfusion, along with shortening operating room time.

We report a four-year-old female with anomalous left coronary artery from the pulmonary artery who developed a large left ventricular (LV) aneurysm following coronary reimplantation in early infancy and subsequent mitral valve repair and replacement for progressive mitral valve regurgitation. While the patient was asymptomatic, echocardiogram demonstrated an enlarged LV aneurysm, which was confirmed by cardiac computed tomography angiography. Surgical exclusion of the aneurysm with a patch and replacement of the prosthetic mitral valve were performed. The etiology of late development of an LV aneurysm is inconclusive but could be associated with prior ischemic injury and additional local myocardial impairment following the mitral valve replacement. Routine postoperative surveillance is recommended.

Background: ABO-Incompatible (ABO-I) heart transplantation (HT) is a promising strategy to extend the hope of HT to many infants and children facing donor organ shortages and waitlist mortality. Despite increasing experience with ABO-I HT and comparable outcomes, universal adoption of this strategy has yet to be achieved. We aimed to provide a contemporary analysis of ABO-I HT with emphasis on the impact of the 2016 United Network for Organ Sharing policy change. Methods: This is a retrospective study of the Organ Procurement and Transplantation Network database examining patients listed for HT at ≤2 years of age in two eras: July 7, 2008, to July 7, 2016, and July 8, 2016, to July 8, 2024, to account for allocation policy changes. The primary outcome was posttransplant survival. Additional outcomes included waitlist mortality, center volume-survival relationship, and incidence of postoperative complications. Results: A total of 2,770 children underwent HT; 493 (18%) were ABO-I recipients. Frequency of ABO-I HT increased across the study period; there was no difference in waitlist mortality for ABO-I eligible candidates across eras (hazard ratio [HR] 0.70, confidence interval [CI 0.48-1.02, P = .07). No differences were observed in one- or five-year survival between ABO-I and ABO-compatible (ABO-C) cohorts. There was no difference in survival among ABO-I recipients between high-volume centers (HVCs) and non-HVCs (HR 0.87, CI 0.43-1.76, P = .70). Conclusions: ABO-Incompatible transplantation offers comparable posttransplant outcomes with ABO-C transplantation, regardless of center volume. The 2016 United Network for Organ Sharing policy has not impacted waitlist mortality for this population. These data provide support for universal adoption of ABO-I HT in appropriately selected patients as the standard of care for infants and children awaiting HT.

PurposeWe reviewed all 181 patients with pediatric and/or congenital heart disease (CHD) who underwent cardiac transplantation at the University of Florida from January 1, 2011, to March 1, 2022, and compared those with CHD with those who had acquired heart disease (AHD).MethodsPatient characteristics were assessed, stratified by CHD versus AHD. Continuous variables are presented as mean (SD); median[interquartile range](range). Categorical variables are presented as N (%). Univariable associations with long-term mortality were assessed with a Cox proportional-hazards model. The impact of CHD versus AHD on mortality was estimated with multivariable models. The Kaplan-Meier method was applied to estimate survival stratified by CHD versus AHD status.ResultsCongenital heart disease was present in 112/181 patients = 61.9% of the total cohort. Acquired heart disease was present in 69/181 = 38.1%. More patients with CHD had prior cardiac surgery (95/112 = 84.8% vs 35/69 = 50.7%, P < .0001) and pretransplant liver dysfunction (19/112 = 17.0% vs 4/69 = 5.8%, P = .037). Congenital heart disease patients had longer bypass times (minutes): 148 (55.2); 137 [113-174] (72-526) versus 108 (40.3);101 [81-125] (59-300), P < .0001; longer cross clamp time (minutes): 85.9 (21.2); 85 [73-100] (49-152) versus 66.3 (14.7); 65 [55-75] (44-106), P < .0001; and lower minimum temperature on bypass (°C): 27.4 (4.3); 28 [24-31] (19-34) versus 31.6 (3.1); 32 [31-34] (20-36), P < .0001. Posttransplant length of stay (days) was longer in CHD patients: 34.5 (26.8); 27 [19-40] (3-158) versus 29.7 (48.2); 18 [15-26] (0-343), P = .0001. In multivariable analysis, CHD remained a risk factor for mortality after controlling for all variables significant in univariable modeling. Overall Kaplan-Meier 5-year survival in all 181 patients (95% confidence interval) = 85.8% (80.0%-92.1%). Kaplan-Meier 5-year survival = 77.4% (68.4%-87.5%) in CHD and 98.5% (95.6%-99.9%) in AHD, P < .0001.ConclusionCongenital heart disease is a risk factor for mortality after cardiac transplantation. Efforts must be made to understand and mitigate this risk.

IntroductionUnplanned readmissions to the pediatric intensive care unit (PICU) following cardiac surgery remain poorly understood. Such readmissions are associated with increased morbidity and present significant challenges to healthcare. This study aimed to identify characteristics associated with unplanned PICU readmission during the same hospitalization following cardiac surgery.MethodWe conducted a retrospective analysis using prospectively collected data from a tertiary care children's hospital from January 2015 to January 2021. All pediatric patients who underwent cardiac surgery and were transferred alive from the PICU were included. Each patient readmitted to the PICU was matched to two controls based on age and PELOD score at the time of initial PICU admission postsurgery to identify factors associated with readmission among 72 variables.ResultsOf the 956 patients discharged alive from the PICU after cardiac surgery, 23 (2.4%) required unplanned readmission. Over half (12/23, 52.2%) of these readmissions occurred within 48 h of PICU discharge. Univariate analysis identified preoperative arrhythmias (P = .037) and postoperative single-ventricle physiology (P = .024) as potential risk factors for readmission. Male sex appeared to be a protective factor against unplanned PICU readmission (P = .026). Although preoperative vasopressor requirement, postoperative altered ventricular function and known pleural effusion at PICU discharge were not significantly associated with PICU readmission, these factors showed a trend toward significance. After multivariate analysis, postoperative single-ventricle physiology remained the sole independent risk factor associated with unplanned PICU readmission with an odds ratio of 8.6 (95% confidence interval, 1.9-46.5).ConclusionWhile unscheduled PICU readmissions following cardiac surgery are rare, postoperative single-ventricle physiology emerged as an independent risk factor.

ObjectiveChildren's HeartLink and the University of California San Francisco (UCSF) have partnered with Vietnam National Children's Hospital (VNCH). Compared with low- and middle-income countries (LMICs) enrolled in the International Quality Improvement Collaborative for Congenital Heart Disease, VNCH is a high performing center. Our goal is to compare outcomes of VNCH with North American centers leveraging data from the Pediatric Cardiac Critical Care Consortium (PC⁴) in 2023.MethodsChildren's HeartLink established a partnership with VNCH in 2017 with a consistent senior-level medical volunteer team from UCSF (Dr Sano currently at Showa University Hospital) engaged in semiannual training visits and weekly case conferences. In-person visits have evolved to hands-off teaching. Areas of improvement are identified, and outcomes presented at the subsequent visit. International Quality Improvement Collaborative and PC⁴ perform site specific audits to confirm data accuracy. Data presented are based on primary operations. Conversion from Risk Adjustment for Congenital Heart Surgery (RACHS-1) to STAT is as follows: RACHS-1 1-4 equal STAT 1-4; RACHS-1 5-6 equal STAT 5.ResultsResults represent 8 on-site visits and 109 case discussions. VNCH performed 1,056 operations, and PC⁴ represents 14,506 operations in 2023. VNCH had comparable outcomes, except higher surgical mortality for infants with prematurity and noncardiac abnormalities, and a higher rate of surgical site infections. VNCH performed fewer operations on patients with noncardiac abnormalities and higher STAT scores.ConclusionsPartnership of highly resourced North American programs with underresourced LMIC centers can elevate congenital heart surgery outcomes. VNCH is a high-volume center with respectable outcomes. Future focus will be higher STAT level and neonatal surgeries.

Patients with dextrocardia, heterotaxy syndrome, and single ventricle physiology typically undergo multiple staged palliative operations culminating in a Fontan circulation. Despite these palliative procedures, heart transplantation may become the inevitable final option.We report the case of a 12-year-old female with dextrocardia, heterotaxy syndrome with right atrial isomerism, and single ventricle physiology who had previously undergone staged Fontan palliation. Due to progressive Fontan failure and clinical deterioration, she was evaluated and listed for OHT.She underwent successful OHT without intraoperative complications. Her postoperative course was uneventful, and she showed significant clinical improvement during follow-up.This case highlights that heart transplantation is a viable and life-saving treatment option for patients with complex congenital heart disease following Fontan failure. Although transplantation in patients with dextrocardia poses technical challenges, it can be performed safely with favorable outcomes.

We present a case of surgical repair of tetralogy of Fallot complicated by a large congenital diaphragmatic hernia as part of the staged management of pentalogy of Cantrell (POC) in a full term 16-week-old infant. The diagnosis was made prenatally, and the patient was born with a large omphalocele, tetralogy of Fallot, and a presumed diaphragmatic hernia. A right ventricular outflow stent was placed at seven weeks of life due to hypoxia. Symptoms were temporarily alleviated but progressed, and the patient received full surgical repair, including repair of a large complex congenital diaphragmatic hernia, right ventricular to pulmonary artery conduit, and left pulmonary arterioplasty at 16 weeks of life. To our knowledge, this case report is among the first to describe the combined interventional and successful surgical management of one of the youngest reported cases of tetralogy of Fallot and POC. Parental consent and IRB approval were obtained.

Although the normal aortic and pulmonary roots have some features in common, they also exhibit important anatomical and functional differences. These differences increase when compared with surgically created neo-aortic roots in individuals with congenitally malformed hearts, with the substrates initially having been either a pulmonary root originating from the right or left ventricle, or a truncal root with variable ventricular origin. With the increasing application and success of these surgeries, our attention has now turned toward understanding late outcomes. Subsequent dilation, usually producing neo-aortic valvar regurgitation, is the most common cause of reoperation in any procedure involving a neo-aortic root. In this review, we describe and compare the detailed anatomy of the normal aortic, pulmonary, and common truncal roots, comparing them with the changes observed in the neo-aortic root following various common surgeries providing biventricular repair for congenital cardiac malformations. We focus on the dilated and dysfunctional neo-aortic root, assessing how the anatomical information relates to contemporary surgical techniques. Furthermore, we aim to review risk factors as they relate to the adverse anatomical features which become evident when the new root is dysfunctional, hoping to provide surgical insight toward optimizing its function and durability.