Relationship Between Central Venous Pressure, Cardiac Index, and Renal Function in Pediatric Heart Failure: a Pediatric Heart Transplant Society Study.

Renal dysfunction (RD) is common in patients with heart failure with or without congenital heart disease, but the determinants of renal dysfunction are not well understood in children with heart failure. Low cardiac output is often discussed as a risk factor for RD.The purpose of this study was therefore to elucidate the relationship between renal function and hemodynamic parameters in children with heart failure.

The Impact of Fontan Circulatory Failure on Heart Transplant Survival: A 20-Center Retrospective Cohort Study.

Background: Fontan circulatory failure (FCF) is a chronic state in palliated single ventricle heart disease with high morbidity and mortality rates, including heart failure, multisystem end-organ disease, and need for heart transplant. Specific FCF morbidities have not been rigorously defined, limiting study of how FCF morbidities affect pre-heart transplant and post-heart transplant outcomes. We hypothesized that FCF-related morbidities affect survival from heart transplant waitlisting through 1 year after heart transplant.

Navigating women with congenital heart disease during pregnancy: Management strategies and future directions.

Women with adult congenital heart disease (CHD) face unique challenges during pregnancy, as gestational cardiovascular (CV) and hemodynamic changes can exacerbate underlying cardiac conditions. While these adaptations are well tolerated in women with structurally and functionally normal hearts, they pose significant risks for those with adult CHD (ACHD), whether repaired, palliated, or with residual defects. Maternal CHD is associated with an increased risk of adverse CV events, including stroke, heart failure, arrhythmias, and thromboembolic complications during pregnancy and the peripartum period.

Contemporary Outcomes for Superior Cavopulmonary Connection in Single Ventricle Palliation: Is There Room for Improvement?

The superior cavopulmonary connection (SCPC) is performed as a part of staged palliation for single ventricle disease. With improvements in interstage management and patient selection, the attrition rate following SCPC is less than 10% in the modern era. We sought to examine the trends and outcomes of SCPC at our institution over the past 14 years.

Cardiac Catheterization and Interventions in Pediatric Patients on ECMO: Analysis of the IMPACT Registry.

Background: There are limited published studies on the performance and safety of cardiac catheterization in pediatric patients on extracorporeal membrane oxygenation (ECMO). We sought to understand the utilization and procedural safety of cardiac catheterization in pediatric patients on ECMO. We also aimed to understand differences in the types of interventions and outcomes in patients with single ventricle (SV) physiology compared to those with biventricular physiology.

Unexpected cardiac interventions including takedown after Glenn surgery: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

Background: Glenn procedure carries low morbidity and mortality within stages of single-ventricle palliation. However, some patients with Glenn failure need a stage reversal, while others require unanticipated surgical interventions. Our understanding of perioperative factors and outcomes associated with such unexpected interventions is extremely limited.

Racial disparities in timing and outcomes for patients undergoing staged single ventricle palliation: a single institution report.

Background: Racial disparities in healthcare have been well documented in the United States. We hypothesise that there will be a racial variance in different clinical variables in single-ventricle patients through stages of palliation.

Materials And Methods: Retrospective single-centre study stratified all single-ventricle patients who reached stage 2 palliation by race: Black and White.

Identifying and characterizing disease subpopulations that most benefit from polygenic risk scores.

Polygenic risk scores (PRSs) hold promise in their potential translation into clinical settings to improve disease risk prediction. An important consideration in integrating PRSs into clinical settings is to gain an understanding of how to identify which subpopulations of individuals most benefit from PRSs for risk prediction. In this study, using the UK Biobank dataset, we trained logistic regression models to predict the 10 year incident risk of myocardial infarction, breast cancer, and schizophrenia using either just clinical features or clinical features combined with PRSs.

Melody Valve Implantation in the Tricuspid Position After Pediatric Heart Transplantation-A Case Report.

Tricuspid regurgitation (TR) is common after a heart transplant and is associated with worse clinical outcomes. The incidence ranges from 34% immediately after transplant to 20% by 10 years. Most patients can be managed medically; however, severe TR and symptomatic right heart failure warrant tricuspid valve replacement.

Critical care therapies pre- and post-heart transplant and their impact: Analysis from the Pediatric Cardiac Critical Care Consortium.

Background: Few studies highlighting the critical care management of patients after heart HTx (HTx) have been published to date. This analysis provides a contemporary representation of pre- and post-HTx critical care in various patient cohorts and outlines the impact of intensive care unit (ICU) therapies on outcomes.

Methods: Data from PC4 Collaborative Registry were analyzed for pediatric patients undergoing HTx between August 2014 and April 2022.

Novel tubing connectors reduce ECMO circuit thrombosis.

Background: Thrombosis within extracorporeal membrane oxygenation (ECMO) circuits is a common complication that dominates clinical management of patients receiving mechanical circulatory support. Prior studies have identified that over 80% of circuit thrombosis can be attributed to tubing-connector junctions.

Methods: A novel connector was designed that reduces local regions of flow stagnation at the tubing-connector junction to eliminate a primary source of ECMO circuit thrombi.

Evaluating threshold for donor fraction cell-free DNA using clinically available assay for rejection in pediatric and adult heart transplantation.

Background: The aims of the study were to assess the performance of a clinically available cell-free DNA (cfDNA) assay in a large cohort of pediatric and adult heart transplant recipients and to evaluate performance at specific cut points in detection of rejection.

Methods: Observational, non-interventional, prospective study enrolled pediatric and adult heart transplant recipients from seven centers. Biopsy-associated plasma samples were used for cfDNA measurements.

Impact of new allocation policy on waitlist and transplant outcomes of adult congenital heart patients supported with ECMO.

Background: The use of ECMO as a bridge to heart transplantation has been growing rapidly in all heart transplant recipients since the implementation of the new UNOS allocation policy; however, the impact on adult congenital heart disease (ACHD) patients is not known.

Methods: We analyzed the UNOS data (2015-2021) for ACHD patients supported with extracorporeal membrane oxygenation (ECMO) during the waitlist, before and after October 2018, to assess the impact on the waitlist and posttransplant outcomes. We compared the characteristics and outcomes of ACHD patients with or without ECMO use during the waitlist and pre- and postpolicy changes.

Research Gaps in Pediatric Heart Failure: Defining the Gaps and Then Closing Them Over the Next Decade.

Given the numerous opportunities and the wide knowledge gaps in pediatric heart failure, an international group of pediatric heart failure experts with diverse backgrounds were invited and tasked with identifying research gaps in each pediatric heart failure domain that scientists and funding agencies need to focus on over the next decade.

Perioperative Morbidity and Outcomes in Pediatric Patients Transitioned From Extracorporeal Membrane Oxygenation to Ventricular Assist Device Support: A Study of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

As a bridge to transplant strategy, children transitioned from extracorporeal membrane oxygenation (ECMO) to ventricular assist device (VAD) have higher waitlist mortality compared with those who receive de novo VAD. However, the contribution of the immediate perioperative period and differences in the two groups are not well studied. We performed a nested case-control study between children receiving de novo VAD (group 1) and those transitioned from ECMO to VAD (group 2) between 2014 and 2019 using The Society of Thoracic Surgeons (STS) database.

Risk Factors for Extubation Failure After Pediatric Cardiac Surgery and Impact on Outcomes: A Multicenter Analysis.

Importance: Extubation failure (EF) after pediatric cardiac surgery is associated with increased morbidity and mortality.

Objectives: We sought to describe the risk factors associated with early (< 48 hr) and late (48 hr ≤ 168 hr) EF after pediatric cardiac surgery and the clinical implications of these two types of EF.

Design Setting And Participants: Retrospective cohort study using prospectively collected clinical data for the Pediatric Cardiac Critical Care Consortium (PC4) Registry.

Impact of Antegrade Pulmonary Blood Flow as Patients Progress Through Single-Ventricle Palliations.

Background: The impact of antegrade pulmonary blood flow (APBF) during single-ventricle (SV) palliation continues to be debated. We sought to assess its impact on the hemodynamic profile and the short- and long-term outcomes of patients progressing through stages of SV palliation.

Methods: A retrospective single-center study was conducted of SV patients who underwent surgery between January 2010 and December 2020.

Impact of the Pediatric ABO Policy Change on Listings, Transplants, and Outcomes for Children Younger Than 2 Years Listed for Heart Transplantation in the United States.

Background: We assessed the impact of the liberalized ABO pediatric policy change on candidate characteristics and outcomes for children undergoing heart transplant (HT).

Methods And Results: Children <2 years undergoing HT with ABO strategy reported at listing and HT from December 2011 to November 2020 to the Scientific Registry of Transplant Recipients database were included. Characteristics at listing, HT, and outcomes during the waitlist and post-transplant were compared before the policy change (December 16, 2011 to July 6, 2016), and after the policy change (July 7, 2016 to November 30, 2020).

Elective and non-elective endomyocardial biopsy in heart transplant patients and procedural outcomes: An IMPACT registry analysis.

Background: Endomyocardial biopsies are standard of care for transplant surveillance, however the procedural risks are not well established, especially in children. The purpose of the study was therefore to assess procedural risks and outcomes associated with elective (surveillance) biopsies and non-elective (clinically indicated) biopsies.

Methods: We used the NCDR IMPACT registry database for this retrospective analysis.

Influence of Body Mass Index in Donor-Recipient Size Mismatch in Pediatric Heart Transplantation.

Background: Body weight is the traditional metric for matching donor and recipient size for pediatric heart transplantation (pHT). We hypothesized that mismatch in body mass index (BMI) or body surface area (BSA) rather than weight is better associated with outcomes of transplantation and therefore should be used for donor-recipient size matching.

Methods: Analysis of the United Network for Organ Sharing database limited to pHT recipients was performed.

Extracorporeal Membrane Oxygenation Cannulation Timing in the Pediatric Myocarditis Population: An Exploratory Analysis From the Extracorporeal Life Support Organization Registry.

Unlabelled: Children presenting with acute myocarditis may experience rapid clinical deterioration requiring extracorporeal membrane oxygenation (ECMO); however, our understanding of best practices and timing of ECMO initiation are lacking. We explored the relationships between pre-cannulation factors and survival in this high-acuity patient population.

Design: Retrospective review of a large international registry.