Evaluation of a Bivalirudin Dosing and Monitoring Protocol in Pediatric Extracorporeal Membrane Oxygenation.

Objective: Bivalirudin is a direct thrombin inhibitor used off-label for systemic anticoagulation in extracorporeal membrane oxygenation (ECMO). There are limited data available in pediatric patients, specifically regarding optimal dosing in this heterogeneous population of patients. This study aimed to characterize bivalirudin use in pediatric patients on ECMO at a single center.

Endobronchial Valve Therapy versus Lung Volume Reduction Surgery in the United States.

Background: Lung volume reduction surgery (LVRS) and endobronchial valve placement (EBV) are therapeutic options in advanced emphysema. We sought to compare the two using a national dataset.

Methods: Using the United States Centers for Medicare and Medicaid Services inpatient claims database, we evaluated beneficiaries with severe emphysema undergoing either LVRS or EBV in accordance with Medicare reimbursement criteria.

Penetrating Pellet Gun Injury to the Neck and Embolization to the Right Ventricle.

Background: Air pellet rifles are marketed and available in the United States as toys despite their ability to cause significant injury. Over 360,000 children were seen in the emergency department for penetrating injuries involving nonpowder firearms between 1990 and 2016.

Case Summary: We report a 10-year-old boy with a penetrating injury to the neck, resulting in embolization of the pellet to the right ventricle through the right internal jugular vein.

Center Volume Not Associated with Survival Benefit of Inter-Hospital Transfer for Pediatric Cardiac Surgery.

To evaluate the relationship between center volume and inpatient mortality among patients transferred to another hospital for pediatric cardiac surgery using contemporary real-world data. The Kids' Inpatient Database (KID) was queried for cardiopulmonary bypass (CPB) cases for the years 2016 and 2019. Hospitals were divided into three groups based on terciles of volume: low: ≤ 103 cases/year, mid: 104-194 cases/year, and high: > 194 cases/year.

A novel familial pathogenic desmoplakin () gene mutation (c.4751_4752del) presenting as "hot-phase" left-dominant arrhythmogenic cardiomyopathy.

Desmoplakin, encoded by (Online Mendelian Inheritance in Man [OMIM]: 125647), is a central component of desmosomes. Mutations in have been implicated in the development of arrhythmogenic cardiomyopathy (ACM) and other cutaneous conditions. We report on a rare, myocarditis-like presentation of left-dominant arrhythmogenic cardiomyopathy (LDACM) in a 16-year-old girl with a novel familial frame-shift c.

Intracardiac Echocardiography Versus Fluoroscopy During Left-Sided Accessory Pathway Ablation in Children and Young Adults: A Retrospective Study.

The use of intracardiac echocardiography (ICE) has been well established for use in catheter ablation of arrhythmias and offers direct visualization of atrial septum and left-sided structures in adults. There, however, is a dearth of data in the pediatric population. The primary objective of this study was to determine the outcomes of left-sided accessory pathway catheter ablation in children and young adults where ICE was used in addition to 3-dimensional (3D)/traditional mapping and to compare outcomes in catheter ablations where only traditional fluoroscopy was used in addition to 3D/traditional mapping.

Surgical vs Transcatheter Aortic Valve Replacement in Patients 65 Years of Age and Older.

Background: Approval of transcatheter aortic valve replacement (TAVR) for all risk profiles has extended TAVR use in patients not otherwise examined in clinical trials. We sought to evaluate contemporary real-world outcomes of surgical aortic valve replacement (SAVR) vs TAVR in Medicare beneficiaries by risk strata.

Methods: Using the US Centers for Medicare Services database, all patients aged 65-85 years undergoing isolated first-time SAVR (n = 34,215) or TAVR (n = 124,897) were evaluated (2018-2022).

Transcatheter vs Surgical Aortic Valve Replacement in Medicare Beneficiaries With Aortic Stenosis and Coronary Artery Disease.

Background: As percutaneous therapeutic options expand, the optimal management of severe aortic stenosis (AS) and concomitant coronary artery disease (CAD) is being questioned between coronary artery bypass grafting with surgical aortic valve replacement (CABG+SAVR) and percutaneous coronary intervention with transcatheter aortic valve replacement (PCI+TAVR). This study sought to compare perioperative and longitudinal risk-adjusted outcomes between patients undergoing CABG+SAVR and patients undergoing PCI+TAVR.

Methods: Using the Centers for Medicare & Medicaid Services inpatient claims database, the study evaluated all patient aged 65 years and older with AS and CAD who were undergoing CABG+SAVR or PCI+TAVR (from 2018 to 2022).

Transcatheter vs Surgical Aortic Valve Replacement in Bicuspid Aortic Valves.

Background: Recent approval of transcatheter aortic valve replacement (TAVR) in patients at lower risk profiles has resulted in a real-world expansion in patients with bicuspid aortic valves (BAV), otherwise excluded from trials comparing TAVR with surgical aortic valve replacement (SAVR). This study compared perioperative and longitudinal outcomes between BAV patients undergoing TAVR vs SAVR.

Methods: Using the United States Centers for Medicare and Medicaid Services inpatient claims database, we evaluated all beneficiaries with BAV undergoing isolated SAVR or TAVR (2018-2022).

Center Volume Not Associated with Survival Benefit of Inter-hospital Transfer for Pediatric CardiacSurger.

Objective: To evaluate the relationship between center volume and inpatient mortality after inter-hospital transfer among patients undergoing pediatric cardiac surgery using contemporary real-world data.

Methods: The Kids' Inpatient Database (KID) was queried for cardiopulmonary bypass (CPB) cases (CPB) for years 2016 and 2019. Hospitals were divided into three groups based on terciles of volume: "low": ≤103 cases/year, "mid":104-194 cases/year, and "high": >194 cases/year.

Concomitant Surgical Ablation in Paroxysmal vs Persistent Atrial Fibrillation During Mitral Surgery.

Background: Despite prospective randomized evidence supporting concomitant treatment of atrial fibrillation (AF) during mitral valve (MV) surgery, variation in surgical management of AF remains. We assessed longitudinal outcomes after surgical treatment of persistent or paroxysmal AF during MV surgery in Medicare beneficiaries.

Methods: All Medicare beneficiaries with a diagnosis of AF undergoing MV surgery (2018-2020) were evaluated.

ENTEROBACTER CLOACAE CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTION.

Enterobacter cloacae cardiac implantable electronic device infections are rare but can be associated with significant morbidity and mortality. We report an 11-year-old female with Enterobacter cloacae infection of a dual-chamber transvenous pacemaker pocket. The report is supplemented by a comprehensive review of the literature on Enterobacter cloacae cardiac implantable electronic device infections.

Surgical versus transcatheter aortic valve replacement in low-risk Medicare beneficiaries.

Objective: Recent approval of transcatheter aortic valve replacement (TAVR) in patients at low surgical risk has resulted in a rapid real-world expansion of TAVR in patients not otherwise examined in recent low-risk trials. We sought to evaluate the outcomes of surgical aortic valve replacement (SAVR) versus TAVR in low-risk Medicare beneficiaries.

Methods: Using the US Centers for Medicare and Medicaid Services claims database, we evaluated all beneficiaries undergoing isolated SAVR (n = 33,210) or TAVR (n = 77,885) (2018-2020).

Atrial Fibrillation Management During Surgical vs Transcatheter Aortic Valve Replacement.

Background: Societal guidelines support atrial fibrillation (AF) treatment during surgical aortic valve replacement (SAVR). Recently, many patients with AF at low to intermediate risk are managed by transcatheter aortic valve replacement (TAVR). Therefore, we evaluated longitudinal outcomes in these populations.

Volume Alone Does Not Predict Quality Outcomes in Hospitals Performing Pediatric Cardiac Surgery.

Background: Lower institutional volume has been associated with inferior pediatric cardiac surgery outcomes. This study explored the variation in mortality rates among low-, mid-, and high-volume hospitals performing pediatric cardiac surgery in the United States.

Methods: The Kids' Inpatient Database was explored for the years 2016 and 2019.

Life-threatening pulmonary haemorrhage treated with coil embolisation followed by lobectomy in a patient with mutation.

mutations are associated with childhood epilepsy, developmental delay, and vascular malformations. We report a child with a likely pathogenic mutation (c.1885A>C, p.

Concomitant Treatment of Atrial Fibrillation in Isolated Coronary Artery Bypass Grafting.

Background: Societal guidelines support concomitant management of atrial fibrillation (AF) in patients undergoing cardiac surgery. To assess real-world adoption and outcomes, this study evaluated Medicare beneficiaries with AF who underwent isolated coronary artery bypass grafting (CABG) with surgical ablation (SA) or left atrial appendage obliteration (LAAO) or both procedures in combination (SA + LAAO).

Methods: The US Centers for Medicare & Medicaid Services inpatient claims database identified all patients with AF who underwent isolated CABG from 2018 to 2020.

Intra-Hisian Wenckebach after surgical closure of conoventricular ventricular septal defect.

We report a 5-year-old girl with transient complete atrioventricular (AV) block following surgical closure of a symptomatic conoventricular ventricular septal defect (VSD) which recovered on post-operative day 9. She later presented with exertional dizziness and fatigue. While congenital cardiac defect repairs are occasionally complicated by complete heart block, this patient was found to have intra-Hisian Wenckebach which is rare in the pediatric population and can be very difficult to discern from surface electrocardiograms and by Holter monitoring.

En Bloc Resection of a Giant Ganglioneuroma of the Chest Through Clamshell Thoracotomy.

Ganglioneuroma is a benign tumor requiring subtotal resection as a primary mode of treatment. There are several surgical approaches. A giant ganglioneuroma of the chest cavity may be approached via a clamshell thoracotomy.

The Evolution of Longitudinal Strain Across Various Univentricular Morphologies Prior to Superior Cavopulmonary Anastomosis.

Background: Infants with single-ventricle physiology have increased morbidity, mortality, and ventricular dysfunction in the pre-superior cavopulmonary anastomosis (pre-SCPA) period. Echocardiography-derived longitudinal strain (LS) is emerging as a reliable marker of single-ventricle performance. We aim to assess evolution of LS during the pre-SCPA period across univentricular morphologies and explore associations of LS with modifiable and nonmodifiable factors.

Milrinone for treatment of elevated lactate in the pre-operative newborn with hypoplastic left heart syndrome.

Background: There is a paucity of information reported regarding the use of milrinone in patients with hypoplastic left heart syndrome prior to the Norwood procedure. At our institution, milrinone is initiated in the pre-operative setting when over-circulation and elevated serum lactate levels develop. We aimed to review the responses associated with the administration of milrinone in the pre-operative hypoplastic left heart syndrome patient.

Relation of Community-Level Socioeconomic Status to Delayed Diagnosis of Acute Type A Aortic Dissection.

Acute type A aortic dissection requires timely diagnosis and intervention. Previous studies have examined risk factors associated with delayed diagnosis; however, the effect of socioeconomic status (SES) has not been previously studied. Our study examined the impact of various SES measures on time to diagnosis.

Postoperative Outcomes in Infants Undergoing ABO-incompatible Heart Transplantation in the United States.

Background: ABO-incompatible heart transplant is a method to increase the infant donor pool. However data on long-term survival and rejection after ABO-incompatible heart transplant in recent era are limited.

Methods: The United Network for Organ Sharing database was queried for infant heart transplants performed from January 2008 to March 2020.