Pediatric Transcatheter Atrial Septal Stent Removal Following ECMO Support Including Use of Novel Retrieval Device.

Left atrial (LA) decompression is often performed in patients on venoarterial extracorporeal membrane oxygenation to help offload the left ventricle. Atrial septal stents may be used to ensure the adequacy of LA decompression; however, if there is cardiopulmonary recovery and extracorporeal membrane oxygenation support is no longer needed, the stents require removal. We describe 3 pediatric patients who required venoarterial extracorporeal membrane oxygenation support and atrial septal stent placement who underwent successful transcatheter removal of the stents after cardiac recovery.

Variation of Prenatal Detection of Congenital Heart Disease in Infants: Updated Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.

Background: Prenatal detection rates of congenital heart disease (CHD) in patients requiring early surgical intervention have been suboptimal, with variability between geographic regions and across defect types. In 2013, obstetric screening ultrasound guidelines were updated, recommending the addition of outflow tract views to improve prenatal detection rates. The objective of this study was to evaluate prenatal detection rates before and after the introduction of outflow tract views in obstetric screening examinations.

Analysis of UNOS: Ventricular assist device as bridge-to-transplant in pediatric patients with congenital heart disease.

Objectives: In a multi-institutional contemporary cohort of patients < 18 years with congenital heart disease (CHD), we compare outcomes of bridge-to-transplant with and without ventricular assist device (VAD).

Methods: UNOS was queried for all patients < 18 years with CHD listed for cardiac transplantation (1/1/2014-12/31/2023). Patients were split into two cohorts based on the presence of VAD while on the waitlist.

100 Episodes of Support with Pulsatile Paracorporeal Ventricular Assist Device in 99 Neonates, Infants, and Children at a single institution.

Background: Unique challenges exist with providing VAD support to neonates, infants, and children with congenital heart disease (CHD), functionally univentricular circulation, and those <5kg. We review our experience with all patients ever supported with Berlin Heart at University of Florida and assess risk factors for mortality and outcomes in high risk subgroups.

Methods: Overall outcomes of 99 patients who underwent 100 separate episodes of support with Berlin Heart were assessed; 47 patients weighed<5kg.

Delayed Sternal Closure in Infants With Congenital Heart Disease: Can Chest Wall Edema Guide Timing?

IntroductionDelayed sternal closure is commonly used after complex congenital cardiac surgery in neonates and infants. The purpose of this study is to assess whether measurements on chest radiography can aid in determining optimal timing for delayed sternal closure.MethodsThis is a retrospective study evaluating 103 neonates and infants <3 months of age who underwent cardiac surgery with delayed sternal closure from January 2018 to June 2021.

Cardiac Transplantation After HYBRID+VAD Support in Patients With HLHS: Technical Considerations and Outcomes.

Background: High-risk patients with hypoplastic left heart syndrome can be supported with combined Hybrid Stage 1 (arterial duct stenting, bilateral pulmonary artery banding, and atrial septectomy if needed) and ventricular assist device (VAD) insertion (HYBRID+VAD) as a bridge to transplantation. Concerns have been raised about the challenges and complexity of the subsequent cardiac transplantation. The purpose of this analysis was to review the investigators' experience with 7 consecutive infants with functionally univentricular ductal-dependent systemic circulation who underwent cardiac transplantation after HYBRID+VAD.

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.

Clinical implications of major haemolysis in children supported by a pulsatile ventricular assist device.

Objective: Haemolysis is developing prominence in the setting of supporting increasingly complex children with heart failure with a ventricular assist device. The goal of this study is to better characterise haemolysis and its implications in children supported with pulsatile ventricular assist devices.

Methods: This is a single-centre retrospective review of 44 children who were supported by Berlin Heart EXCOR between January 2006 and June 2020.

Tailored preoperative assessment in neonatal cardiac surgery: a European Congenital Heart Surgeons Association study†.

Objectives: Current preoperative counselling in neonatal cardiac surgery is mainly focused on the primary procedure. However, other factors must be considered when evaluating the surgical risk of a neonate. We aimed to develop a risk adjustment model to personalize preoperative counselling using data from the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).

Aortic valve surgery in adolescents and young adults: analysis of early operative data from the European Congenital Heart Surgeons Association database†.

Objectives: Aortic valve surgery is a crucial treatment for congenital and acquired aortic disease in adolescents and young adults. This study evaluated outcomes in this group by analysing data from the European Congenital Heart Surgeons Association Congenital Cardiac Database (ECCDB).

Methods: A retrospective review included patients aged 10-18 years from the ECCDB who underwent aortic valve surgery between 2013 and 2022.

Historical, Cultural, and Structural Barriers for Cardiac Surgery in Sub-Saharan Africa: Lessons Learned From Angola.

Cardiac surgery (CS) in sub-Saharan Africa (SSA) faces unique challenges that go beyond resource scarcity. Historical, cultural, and structural barriers continue to hinder the development of the specialty in SSA, impacting professional accreditation and the organization of healthcare systems. The colonial legacy of the subcontinent has shaped health systems in ways that often sustain external dependency, limiting local autonomy, which is particularly true for a high-resource subspecialty such as CS.

One-year clinical outcomes of an observational study of static lung preservation at 10° centigrade and semi-elective lung transplantation.

Purpose: Lung transplantation (LTx) is performed as soon as donor organs are made available to minimize cold ischemic time. Studies have suggested that an extended static preservation of donor lung allografts at 10°C may offer similar clinical outcomes with the added benefits of surgery being performed as a semi-elective (SE) procedure. The purpose of our study was to compare the clinical outcomes between a cohort of patients who underwent LTx in the traditional fashion and after a period of static preservation at 10°C.

Analysis of 112 Patients With Congenital Heart Disease Undergoing Cardiac Transplantation: Impact of Pretransplant Ventricular Assist Device.

BackgroundWe reviewed our management strategy and outcome data for all 112 patients with congenital heart disease (CHD) who underwent cardiac transplantation at University of Florida from January 2011, to January 2022, and evaluated the impact of a pretransplant ventricular assist device (VAD).MethodsContinuous variables are presented as mean (SD); median [interquartile range] (range); categorical variables are presented as N (%). Univariable associations with long-term survival were assessed with Cox proportional hazards models.

A Single-Center Experience With En-Bloc Combined Heart+Liver Transplantation: Analysis of Eight Cases, Including Two Heart+Liver+Kidney Transplants.

ObjectivesReview our clinical experience with eight patients at the University of Florida undergoing En-bloc combined heart+liver transplantation (ECH + LTX).MethodsContinuous variables are reported as median (interquartile range = IQR) and categorical variables are reported as N (%).ResultsEight patients underwent ECH + LTX between August 2020 and May 2023 at the University of Florida, with triple heart+liver+kidney transplantation performed in 2/8 = 25%.

Tracheobronchoplasty via a right posterolateral thoracotomy.

Tracheobronchomalacia is a condition of dynamic airway collapse due to weakness of the tracheobronchial wall. When conservative management, including continuous positive airway pressure, fails to control symptoms or improve quality of life, surgical intervention may be warranted. In this case report, we present a surgical technique of tracheobronchoplasty via the right posterolateral thoracotomy in a patient with severe tracheobronchomalacia.

Transcervical tracheal resection.

Postintubation subglottic tracheal stenosis remains a prevalent complication in patients who require prolonged periods of intubation, with an incidence of up to 11%. Transcervical tracheal resection and reconstruction remain the gold standards for definitive treatment of stenotic regions that fail trials of non-surgical interventions, including local steroid injections, cryotherapy and balloon dilation. Despite its high success rate, it is one of the more technically difficult procedures in thoracic surgery.

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.

Methylprednisolone for Infant Heart Surgery: Subpopulation Analyses of a Randomized Controlled Trial.

Objectives: Evaluate benefits and harms of prophylactic intraoperative methylprednisolone in subpopulations undergoing infant heart surgery.

Design: Subpopulation analyses of The Steroids to Reduce Systemic Inflammation after Infant Heart Surgery (STRESS) trial, a double-blind randomized placebo-controlled trial.

Setting: Twenty-four congenital heart centers.

Optimal pretransplant duration with HeartMate III left ventricular assist device: A contemporary analysis.

Background: This study evaluates the impact of pretransplant HeartMate III (HM3) left ventricular assist device (LVAD) support duration on post-transplant survival in a contemporary cohort.

Methods: A retrospective review of the United Network for Organ Sharing database was conducted for adult heart transplant recipients from January 2019 to December 2023 who were bridged with an HM3 LVAD. We utilized a restricted cubic spline fitted to a Cox proportional hazards model to stratify patients into duration groups based on risk inflection points (<1, 1-2, and >2 years), and outcomes were compared between and across groups.

100 Episodes of Support With Berlin Heart: Comparison of Patients Who Underwent Ventricular Assist Device Explantation After Cardiac Recovery With Those Without Cardiac Recovery.

Background: We report our first 100 episodes of patient support with a pulsatile paracorporeal ventricular assist device (VAD) (Berlin Heart). Characteristics and outcomes of those patients who underwent VAD explantation after native ventricular recovery (n = 7) are compared with those of patients without ventricular recovery supported as a bridge to transplantation (n = 92 who underwent 93 episodes of VAD support).

Methods: Comparisons between the 2 cohorts were made using descriptive statistics: count (n), median and interquartile range (IQR; Q1-Q3), and range (range).

Reexploring the STRESS Trial: Subgroup Postoperative Outcomes Following Methylprednisolone for Infant Heart Surgery.

Unlabelled: Objective Assess the association between intraoperative methylprednisolone and specific postoperative outcomes among subgroups undergoing infant heart surgery.

Design: Subpopulation analyses of The Steroids to Reduce Systemic Inflammation after Infant Heart Surgery trial, a double-blind randomized placebo-controlled trial.

Setting: 24 congenital heart centers.

Arterial revascularization of the left coronary artery after Kawasaki disease in a paediatric patient.

Kawasaki disease is a vasculitis of childhood, with the development of coronary artery aneurysms a well-known sequela. We present a case of an adolescent male who presented with a large left main coronary artery aneurysm and describe operative repair with coronary artery bypass grafting.

Pediatric and Congenital Cardiac Services: An Innovative and Empowering Approach to Global Training and Equitable Care.

Congenital heart disease is a leading cause of preventable death in children, with a disproportionate impact on low- and middle-income countries. Despite progress in treating congenital heart disease globally, significant challenges remain in accessing specialized cardiovascular care, particularly cardiac surgery, in low- and middle-income countries. This review examines current models of assistance and proposes a novel global training program to address these inequities.