Outcomes of Fontan Patients Undergoing Combined Heart-Liver Transplantation in Pediatric Hospitals Across the United States.

Objective: With increasing patients successfully surviving Fontan palliation, there is a rise in Fontan associated liver disease (FALD) and transplant strategies inclusive of combined heart-liver transplantation (CHLT). Therefore, we reviewed a combined dataset assessing outcomes of pediatric patients undergoing CHLT.

Methods: Patients undergoing Fontan CHLT from 2010-2024 at pediatric hospitals were queried from a merged dataset of the Pediatric Health Information System and United Network for Organ Sharing.

Ex Vivo Hydrodynamic Assessment of Expanded Polytetrafluoroethylene Trileaflet Pulmonary Valves.

Handmade trileaflet valves using expanded polytetrafluorethylene (ePTFE) have been considered a viable option for pulmonary valve replacement. Studies have performed ex vivo testing of adult sized valves, data on pediatric-sized ePTFE valves is limited. Our aim was to evaluate pediatric-sized ePTFE valves and ovine tissue valves as comparison to assess performance.

Contrasting the Performance of a Surgeon-Fashioned Extracellular Matrix Cylindrical Tricuspid Valve Versus a Mechanical Valve.

We present a patient who as an infant required mitral and tricuspid valve replacement, with a mechanical valve used in the mitral position and a surgeon fashioned extracellular matrix of porcine small intestinal submucosa (SIS-ECM) (CorMatrix) valve in the tricuspid position. Five years later, the mechanical valve required replacement with a larger mechanical valve. Although the CorMatrix tricuspid valve did not show significant signs of thrombosis or calcification, it was also replaced with a mechanical valve.

Safety and Feasibility of Implanting Dual-Chamber Permanent Pacemakers in Patients Under 3 kg.

Permanent pacing in the young pediatric population can be challenging, especially in small neonates. We describe our institutional experience with the surgical placement of dual-chamber permanent pacemaker (PPM) systems in neonates weighing <3 kg at the time of implantation. The Cincinnati Children's Hospital database was used to identify patients who had an epicardial dual-chamber PPM and weighed <3 kg at implantation from 2000 to 2022.

Stabilizing the Unstable: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database of Children Supported With Extracorporeal Membrane Oxygenation Before Cardiac Surgery.

Background: Children with heart disease and cardiopulmonary failure may be supported with extracorporeal membrane oxygenation (ECMO) for stabilization before cardiac surgery. This study describes their epidemiology and outcomes.

Methods: The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for patients aged <18 years who underwent ECMO cannulation before and subsequently underwent their index surgery of that hospitalization from January 2016 to June 2021.

Awareness, Attitudes, and Perceptions Toward Partial Heart Transplantation.

Objective: Partial heart transplantation (PHT) is a new procedure that delivers growing heart valve implants for children. However, awareness, attitudes, and perceptions of health care professionals regarding PHT remain unexplored.

Methods: A national survey was conducted among members of the Congenital Heart Surgical Society, pediatric cardiac intensive care unit (ICU) directors, medical students, and organ procurement organization (OPO) representatives.

Utilizing artificial intelligence and medical experts to identify predictors for common diagnoses in dyspneic adults: A cross-sectional study of consecutive emergency department patients from Southern Sweden.

Objective: Half of all adult emergency department (ED) visits with a complaint of dyspnea involve acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (eCOPD), or pneumonia, which are often misdiagnosed. We aimed to create an artificial intelligence (AI) diagnostic decision support tool to detect patients with AHF, eCOPD, and pneumonia among dyspneic adults at the beginning of their ED visit.

Methods: In this cross-sectional study, we included all ED visits of patients 18 years or older with dyspnea at two regional Swedish EDs 07/01/2017-12/31/2019.

Transposition of the Great Arteries With Intact Ventricular Septum and Left Ventricular Outflow Tract Obstruction: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).

PurposeTransposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is a rare congenital cardiac malformation. This study aims to describe the operations performed for patients with TGA + IVS + LVOTO in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and review their short-term outcomes.MethodsA total of 112 patients with the diagnosis of TGA + IVS + LVOTO in the STS-CHSD who underwent cardiac surgery between January 1999 and June 2021 were included.

Timing of Arterial Switch Operation in Dextro-Transposition of Great Arteries with Intact Septum: Factors Associated with Delay, Practice Variation, and Associated Outcomes.

We examined the current practice, factors associated with delay, and impact of timing of arterial switch operation (ASO) on outcomes of d-transposition of great arteries (d-TGA) with intact ventricular septum (IVS). Neonates with d-TGA + IVS undergoing ASO were identified from the Pediatric Health Informational System database. Factors associated with delayed repair, practice trends, and outcomes related to surgical timing were analyzed.

Aspirin Use Following the Arterial Switch Operation in the United States: Variability, Trends, and Perioperative Outcomes.

BackgroundAspirin has the potential of offering coronary arterial protection from thromboembolism for patients following the arterial switch operation (ASO) but is used inconsistently and the benefits are unknown. We sought to discern trends and outcomes associated with the use of aspirin following the ASO.MethodsPatients undergoing the ASO were identified from the Pediatric Health Information System and divided into two groups: those who received aspirin post-ASO versus the nonaspirin group to evaluate trends, variations, and outcomes.

The Increasing Utilization of the Impella Device as a Bridge-to-Transplantation in Pediatric Heart Centers Across the United States.

ObjectiveReports on the use of the Impella device in children undergoing heart transplantation have been limited. We sought to provide what is to our knowledge the first multi-institutional national report of pediatric Impella device utilization as a bridge-to-heart transplant strategy.MethodsAll patients (<18 years) who underwent Impella placement in the United Network for Organ Sharing (UNOS) from the first use in 2013 to June 2024 were identified.

Is timing as critical for repair of dextro-transposition of the great arteries with ventricular septal defect without outflow tract obstruction?

Objective: We sought to explore the role of timing on outcomes of the arterial switch operation + ventricular septal defect closure.

Methods: Neonates undergoing the arterial switch operation + ventricular septal defect closure from the Pediatric Health Information System database (2004-2022) were identified. Patients with outflow tract obstruction were excluded.

Can Children With a VAD Overcome Intellectual and Motor Disabilities After Heart Transplantation in the United States?

Background: Ventricular assist devices (VADs) can be associated with high rates of neurologic complications. This study investigated whether children with VADs continue to exhibit psychomotor impairment after heart transplantation (HTx).

Methods: The United Network for Organ Sharing was queried for children who underwent VAD implantation and HTx (2008-2024).

Contemporary Practice of Native Coarctation in Children Greater Than One Year of Age: A Society of Thoracic Surgeons Analysis.

ObjectiveLimited data exist on surgical repairs for native coarctation of the aorta (Native-CoA) after year-one of life. We sought to establish surgical outcomes benchmark of older Native-CoA repair patients.MethodsAll patients greater than one year of age who underwent off-pump Native-CoA repair were identified from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) between January 1998 and December 2022.

Total Anomalous Pulmonary Venous Return, Marfan Syndrome, and Severe Combined Immunodeficiency: A Lethal Combination?

The authors present an exceptionally rare case of a newborn in whom total anomalous pulmonary venous return (TAPVR) had been diagnosed prenatally and in whom genetic testing after neonatal cardiac repair confirmed a missense variant of the gene consistent with Marfan syndrome as well as a gene mutation associated with severe combined immunodeficiency. To the authors' knowledge, this is the first reported case with this unique combination. Neonatal TAPVR repair was undertaken with a good postoperative outcome and survival until the last follow-up.

Fate of Semilunar Valves From Discarded Hearts at the Time of Pediatric Heart Retransplantation.

Background: Partial heart transplantation (PHT) is a novel procedure for children in need of a growing valve replacement option. One challenge is identifying suitable donor valves. Semilunar heart valves from patients receiving a retransplant may be a source, however their functionality and growth potential especially at the time of retransplant are unknown.

A novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients based on complete data from an entire health care system.

Background: Dyspnoea is one of the emergency department's (ED) most common and deadly chief complaints, but frequently misdiagnosed and mistreated. We aimed to design a diagnostic decision support which classifies dyspnoeic ED visits into acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (eCOPD), pneumonia and "other diagnoses" by using deep learning and complete, unselected data from an entire regional health care system.

Methods: In this cross-sectional study, we included all dyspnoeic ED visits of patients ≥ 18 years of age at the two EDs in the region of Halland, Sweden, 07/01/2017-12/31/2019.

Unintended Sequalae of Long-Term Transvenous Pacemaker Leads in a Patient With Congenital Heart Disease.

Long-term use of transvenous pacemakers, a common modality used for symptomatic bradyarrhythmias, can lead to rare but significant complications, especially in patients with congenital heart disease. We present a complex and challenging surgical lead extraction for a patient with long-standing superior vena cava syndrome resulting from prolonged transvenous leads.

Outcomes in Children Who Undergo Postcardiotomy Extracorporeal Membrane Oxygenation: A Report From the STS-CHSD.

Background: Children who undergo cardiac surgery may require postcardiotomy extracorporeal membrane oxygenation (ECMO). Although morbidities are considerable, our understanding of outcome determinants is limited. We evaluated associations between patient and perioperative factors with outcomes.

Long-term outcomes following the Ross procedure in neonates and infants: A multi-institutional analysis.

Objectives: For neonates and infants with aortic valve pathology, the Ross procedure historically has been associated with high rates of morbidity and mortality. Data regarding long-term durability are lacking.

Methods: The international, multi-institutional Ross Collaborative included 6 tertiary care centers.