Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf178. doi: 10.1093/ejcts/ezaf178.
ABSTRACT
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).
METHODS: A retrospective, multicentre analysis of the ECHSA-CD dataset was conducted, including 20 687 neonates undergoing cardiac surgery between 2013 and 2022. A risk adjustment model was developed on a training set (70%) and validated on a separate cohort (30%).
RESULTS: A model incorporating age, weight, STAT mortality category and need for cardiopulmonary bypass (CPB) demonstrated good predictive performance. Lower age (≤10 days), lower weight (<2.5 kg), higher STAT category and need for CPB were associated with increased risk of operative mortality. The model's area under the receiver operating characteristic curve was 0.701 in the training set and 0.700 in the validation set, indicating good discrimination. Additionally, the Brier quadratic probability score was 0.08 in both datasets, indicating good calibration.
CONCLUSIONS: This study underscores the importance of patient characteristics in predicting outcomes in neonatal cardiac surgery. The developed risk adjustment model can be used as a tool in preoperative counselling, decision-making and risk stratification for neonates undergoing cardiac surgery. By providing a more accurate estimate of operative mortality, this model can help families make more informed decisions about their child's care and improve the overall quality of care for neonates with congenital heart defects.
PMID:40577097 | DOI:10.1093/ejcts/ezaf178
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 27:ivaf153. doi: 10.1093/icvts/ivaf153. Online ahead of print.
ABSTRACT
OBJECTIVES: This study sought to evaluate the feasibility and learning curve of right vertical infra-axillary thoracotomy (RVIAT) in surgical closure of VSD.
METHODS: Clinical outcomes in paediatric patients (<18 years) undergoing VSD surgery between 2018 and 2021 in two tertiary hospitals were retrospectively reviewed. After 1:1 propensity score matching, patients undergoing RVIAT were compared with those undergoing median sternotomy (MS). The learning curve that reflected the number of cases needed to achieve technical proficiency was measured using total operating time as a metric, and was evaluated using a risk-adjusted cumulative sum analysis.
RESULTS: Of the 3515 eligible patients, 2183 (62%) underwent MS and 1332 (38%) underwent RVIAT. After matching, 797 cases in RVIAI and MS group were recorded respectively. Propensity weighting produced excellent balance in patient baseline characteristics including age, weight, and VSD subtypes. There was no between-group difference in postoperative rhythm disturbances (0.6% vs 1.1%; P = 0.83), significant residual VSD (0.1% vs 0.4%, P = 0.62), and reoperation within postoperative 60 days (0.1% vs 0.9%, P = 0.07). RVIAT provided better cosmesis (satisfactory score: 9.21 ± 0.06 points vs 6.98 ± 1.17 points; P < 0.001), shorter median length of hospital stay (5.5 days vs 8.0 days, P < 0.001), and lower cost (8513.3 ± 3193.2 USD vs 9222.3 ± 2504.9 USD; P < 0.001). The surgeons could conquer the early learning phase of RVIAT after performing a mean of 41 operations.
CONCLUSIONS: RVIAT can combine good outcomes with favourable cosmesis in VSD repair, and sufficient exposure to RVIAT procedures is crucial for proficiency.
PMID:40576448 | DOI:10.1093/icvts/ivaf153
Front Cardiovasc Med. 2025 Jun 12;12:1568920. doi: 10.3389/fcvm.2025.1568920. eCollection 2025.
ABSTRACT
INTRODUCTION: The surgical and medical management of aging patients with adult congenital heart disease (ACHD) continues to innovate to meet the evolving needs of this unique patient population, leading to improved life expectancy and quality of life. However, the ACHD population is characterized by high morbidity and mortality. With this study, we aim to describe patient characteristics and surgical outcomes for the over fifty ACHD cardiac surgical cohort, focusing on risk factors for mortality and major complications.
METHODS: This was a retrospective cohort study including ACHD patients undergoing surgical repair from January 2004 to March 2023. Primary outcome was the composite of severe postoperative complications and secondary outcomes were 1-year mortality, ICU stay and hospital length of stay. Descriptive statistics, univariable and multivariable logistic regression models were used.
RESULTS: In the study period, 1381 patients with ACHD underwent cardiac surgery, of which 292 (20.5%) were over 50 years. In the overall group, the most common primary surgery was pulmonary valve replacement in 411 (29.8%), in the over 50 group this was ASD and VSD repairs in 102 (34.9%). The composite of major postoperative complications was different between the overall group and the over 50 years group (10.7% vs. 13.7%; P = 0.049), which in the over 50 group was associated with CPB time (180 min vs. 104 min, OR 1.01; 95%CI 1.00-1.03), and preoperative creatinine levels (84 vs. 77, OR 1.01; 95%CI 1.00-1.03). No difference was seen in 1-year mortality (P = 0.415).
CONCLUSION: With careful patient selection and preoperative optimization, surgical risks remain low, even in aging ACHD patients. Although overall mortality rates are low, postoperative complications increase, and patients over 50 with DM, renal failure, long pump runs or postoperative stroke are at highest risk.
PMID:40574821 | PMC:PMC12198246 | DOI:10.3389/fcvm.2025.1568920
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6):ivaf145. doi: 10.1093/icvts/ivaf145.
ABSTRACT
Persistent fifth aortic arch (PFAA) is a rare variant of the aortic arch that may be associated with coarctation or interrupted aortic arch. We report the case of a neonate initially referred for coarctation repair. After a left thoracotomy was performed, a rare diagnosis of PFAA associated with interrupted aortic arch was made. Despite this unusual anatomy, the repair was successfully performed via a lateral approach. This unusual anatomy of the aortic arch deserves special consideration in case of association with coarctation. Indeed, repair from the side may not be possible due to the common origin of the neck-vessels, and resection should be extended as far as possible to eliminate remaining ductal tissue and prevent recoarctation.
PMID:40574475 | DOI:10.1093/icvts/ivaf145
Naunyn Schmiedebergs Arch Pharmacol. 2025 Jun 26. doi: 10.1007/s00210-025-04252-2. Online ahead of print.
ABSTRACT
Nitric Oxide Synthase 3 (NOS3) G894 T (rs1799983) is an important regulator of cardiac development. Its role in congenital heart disease (CHD) has been extensively studied in recent years, but the results are contradictory. The aim of the present study was to better elucidate the relationship between the NOS3 G894 T gene polymorphism and susceptibility of CHD and its specific subtypes. A comprehensive literature search was conducted across several databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, and Wan Fang. Meta-analysis was carried out using RevMan 5.4 software, and the odds ratio (OR) with 95% confidence intervals (CI) was used as the effect measure. Additionally, bioinformatics analysis was employed to explore the impact of NOS3 gene mutations on tetralogy of Fallot (TOF), using publicly available microarray datasets to assess NOS3 gene expression. Nine studies were included, comprising 1931 CHD cases and 1910 controls. Meta-analysis showed that the NOS3 G894 T polymorphism was associated with an increased risk of CHD in three genetic models: allele model (T vs G, OR = 1.31, 95% CI [1.02, 1.68], P = 0.04), homozygous model (TT vs GG, OR = 1.60, 95% CI [1.13, 2.26], P = 0.007), and dominant model (GT + TT vs GG, OR = 1.44, 95% CI [1.02, 2.05], P = 0.04). Subgroup analyses revealed a strong association with atrial septal defect (ASD), conotruncal defects (CTD), and septal defects, with the most significant correlation found for ASD. The NOS3 G894 T polymorphism was associated with the risk of CHD in ethnic subgroup, increasing the risk of CHD in white race. Bioinformatics analysis did not find significant differences in NOS3 gene expression between individuals with TOF. The NOS3 G894 T (rs1799983) gene polymorphism is significantly associated with the risk of CHD, with notable variations in this association across different regions and ethnic groups. The T allele increases the risk of CHD by 31% compared to the G allele. Additionally, this polymorphism is linked to specific CHD subtypes, especially ASD.
PMID:40571825 | DOI:10.1007/s00210-025-04252-2
Eur J Cardiothorac Surg. 2025 Jun 3;67(6):ezaf101. doi: 10.1093/ejcts/ezaf101.
ABSTRACT
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. The primary outcome was operative mortality, defined as death within 30 days or during hospitalization. Secondary outcomes included reoperations and postoperative complications. Risk factors for mortality were identified using multivariable logistic regression analysis, and surgical trends were evaluated.
RESULTS: A total of 2129 patients were included, with the majority undergoing valve replacement, followed by valve repair and the Ross procedure. Patients receiving valve replacement were typically older and larger. Over the decade, there was an increase in the use of the Ross procedure. Reoperations were more frequent in the repair group, while postoperative complications were more common in the replacement group. The overall mortality rate was 1.5%. Independent risk factors for mortality included longer cardiopulmonary bypass (CPB) times (odds ratio 1.1, P < 0.001) and annulus enlargement (odds ratio 3.8, P = 0.02). CPB durations exceeding 240 min increased the risk of death. The Ross procedure, particularly in isolated cases without annulus enlargement, was associated with a low mortality rate of 0.4%.
CONCLUSIONS: Aortic valve surgery in adolescents and young adults is complex, with outcomes influenced by CPB time and annulus enlargement. The Ross procedure shows excellent results despite its technical demands.
PMID:40569172 | PMC:PMC12208064 | DOI:10.1093/ejcts/ezaf101
Eur J Cardiothorac Surg. 2025 Jun 26:ezaf214. doi: 10.1093/ejcts/ezaf214. Online ahead of print.
ABSTRACT
OBJECTIVES: Patients with endocardial fibroelastosis (EFE) in the setting of congenital critical aortic valve (AoV) stenosis and left ventricular outflow tract obstruction (LVOTO) are at risk for diastolic dysfunction, limiting biventricular circulation. EFE resection is the only available treatment option, but frequently recurs requiring re-resections. We aimed to investigate whether augmentation of a left ventricular outlet stenosis (AoV stenosis ± LVOTO) with a Ross/Ross-Konno procedure prevents EFE recurrence.
METHODS: Patients born with AoV stenosis ± LVOTO and treated with primary left ventricular (LV) EFE resection at the study centers from 01/2010 to 12/2021 were included in the study. The inclusion criteria for this retrospective analysis was the presence or absence of a Ross/Ross-Konno procedure for the treatment of a modifiable risk factor of EFE recurrence. Retrospective allocation to either the non-Ross or Ross/Ross-Konno group was carried out accordingly. The primary outcome measure was EFE recurrence.
RESULTS: Ninety-three patients were screened, and 60/93 patients (64.5%) met all inclusion criteria. Within those 60 patients, 5/23 (20.7%) in the Ross/Ross-Konno group had EFE recurrence compared to 23/37 (62.2%) in the non-Ross group (difference = 40.5%, 95% confidence interval: 14.6% to 58.7%, P = 0.003), and were less likely to develop EFE recurrence with adjusted hazard ratio of 4.07 (95% CI: 1.38, 12.0, P = 0.011) and 3.69 (95% CI: 1.31, 10.42, P = 0.014) when including death as a competing event.
CONCLUSIONS: This study found that patients after a Ross/Ross-Konno procedure were less likely to experience EFE recurrence and reinterventions on the LVOT/AoV were significantly reduced. However, patient selection and timing of a Ross/Ross-Konno procedure to prevent EFE recurrence have yet to be identified through prospective trials.
PMID:40569053 | DOI:10.1093/ejcts/ezaf214
World J Pediatr Congenit Heart Surg. 2025 Jun 26:21501351251345790. doi: 10.1177/21501351251345790. Online ahead of print.
ABSTRACT
Congenital sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly with an incidence ranging from 0.1% to 3.5% of all congenital heart disease. Sinus of Valsalva aneurysm involving more than one sinus of Valsalva is very rare and dangerous. Valve-sparing root replacement is a safe and effective procedure that preserves growth potential for the aortic valve and has some benefits compared with valve replacement. There are limited data on valve-sparing operations in neonates and young children. In this case report, we present the surgical correction of an isolated, unruptured, multiple SVA in a 1.4-year-old child using the Yacoub II valve-sparing procedure.
PMID:40567013 | DOI:10.1177/21501351251345790
World J Pediatr Congenit Heart Surg. 2025 Jun 26:21501351251345805. doi: 10.1177/21501351251345805. Online ahead of print.
ABSTRACT
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. Additionally, cultural resistance, the undervaluation of the specialty, and a lack of institutional recognition create a difficult environment for African cardiac surgeons. Based on the recent experience in Angola, this article explores these challenges and highlights the need for context-specific solutions, including strengthening local training, improving hospital governance, and prioritizing CS as a public health necessity. Understanding these obstacles and their potential solutions is crucial to fostering sustainable progress and ensuring equitable access to cardiovascular care in the region and in similar environments.
PMID:40567009 | DOI:10.1177/21501351251345805
World J Pediatr Congenit Heart Surg. 2025 Jun 26:21501351251345787. doi: 10.1177/21501351251345787. Online ahead of print.
ABSTRACT
We report the case of a four-month-old child with complex congenital heart disease, including tricuspid atresia, absent pulmonary valve, hypoplastic right ventricle, right ventricular coronary artery fistula, and Uhl anomaly, and to describe the challenges and management decisions involved. A Blalock-Taussig-Thomas (BTT) shunt was initially planned. However, severe ST-segment depression occurred upon oral feeding, indicating coronary insufficiency. Cardiac catheterization revealed a single coronary artery with a right ventricular coronary artery fistula, which increased the risk of myocardial ischemia with the BTT shunt. Consequently, a bidirectional Glenn (BDG) procedure with left pulmonary artery reconstruction was performed after maintaining ductal patency with prostaglandin for four months. The patient had a favorable postoperative course without ischemic events. In patients with complex congenital heart defects and coronary anomalies, the presence of a right ventricular coronary artery fistula may increase the risk of ischemia with a BTT shunt. A BDG procedure can offer a safer alternative, leading to a positive clinical outcome and avoiding ischemic complications.
PMID:40566964 | DOI:10.1177/21501351251345787
J Clin Med. 2025 Jun 18;14(12):4355. doi: 10.3390/jcm14124355.
ABSTRACT
Background/Objectives: Heart failure (HF) poses a major challenge in managing adults with congenital heart defects (ACHD). Emerging evidence suggests that HF in ACHD increases the risk of underweight due to heightened metabolic demands, gastrointestinal complications, and psychological factors such as anxiety and depression. Despite its critical implications, few studies have examined this association. This study evaluates the relationship between HF and underweight-defined as a body mass index (BMI) < 18.5-in ACHD. Methods: The Pathfinder-CHD Registry is a prospective, observational, web-based HF registry including ACHD with manifest HF, history of HF, or significant risk for HF. It documents congenital diagnoses, HF type, comorbidities, and treatments. Patients were categorized by BMI into mild (17.00-18.49), moderate (16.00-16.99), and severe (<16.00) underweight. Results: As of September 2024, the registry enrolled 1420 adults (mean age 31.8±11.3 years; 49.2% female). Underweight was present in 59 patients (4.2%): 62.7% mild, 18.6% moderate, and 18.6% severe. Among the remaining 1361 patients, 52.8% had normal weight, 32.8% were overweight, and 14.2% were obese. Women had significantly lower metabolic body weight than men (p = 0.002). Underweight correlated with younger age (p < 0.001) and CHD type (p = 0.02). Notably, 42.9% of underweight patients had cyanotic CHD. Conclusions: Underweight is an underrecognized problem in ACHD with HF. Adults with complex CHD or connective tissue disorders are disproportionately affected. Underweight should be seen as an alarm sign requiring personalized, multidisciplinary management, including nutritional support, tailored therapy, and close monitoring to improve outcomes.
PMID:40566101 | PMC:PMC12194136 | DOI:10.3390/jcm14124355
Children (Basel). 2025 Jun 16;12(6):782. doi: 10.3390/children12060782.
ABSTRACT
Background: Severe neonatal Ebstein's anomaly (EA) is associated with a high risk of mortality. A new therapeutic approach aims to combine the advantages of Starnes' procedure in stabilizing critically ill neonates with the long-term superiority of biventricular physiology after cone reconstruction. Case report: The echocardiography of a male preterm (36 weeks' gestation; birth weight 2400 g) demonstrated EA Carpentier type C, membranous pulmonary atresia, and hypoplastic pulmonary arteries (PAs). After undergoing the Starnes procedure postnatally, multiple dilatations of the AP shunt and the Starnes fenestration followed. Cone reconstruction was performed at 15 months of age. Surgical revision addressed tricuspid and pulmonary valve insufficiency and PA bifurcation stenosis. Subsequently, PA branch stenosis with severe impairment of right ventricular function and dilatation required stent implantation. At the last follow-up, at 3 years of age, the patient was asymptomatic with sufficient exercise tolerance. Discussion: The American Association for Thoracic Surgery recently recommended evaluating all Starnes patients for potential conversion to cone. Consequently, the Starnes procedure should be modified to facilitate subsequent biventricular correction. Both the optimal timing of conversion and the appropriate assessment to reliably evaluate feasibility and the prospects for success require further investigation. Conclusions: Conversion from Starnes to cone is technically feasible, even in cases of severe EA, prematurity, low birth weight, and additional cardiac comorbidities, and provides promising initial results. Further research is needed to define candidacy and the optimal timing of conversion, and to assess long-term outcomes. The high therapeutic effort and complexity make this treatment approach suitable only for quaternary centers.
PMID:40564740 | PMC:PMC12191472 | DOI:10.3390/children12060782
Children (Basel). 2025 Jun 13;12(6):767. doi: 10.3390/children12060767.
ABSTRACT
Objectives: In the neonatal period, 25% of cases with critical congenital heart disease (CCHD) require surgical or interventional palliative and corrective procedures. Prenatal diagnosis and timely intervention can positively impact neonatal mortality and morbidity. This study evaluated the effects of perinatal follow-up on the management of CCHD. Methods: The study was conducted on term neonates diagnosed with CCHD, who were monitored in the neonatology and pediatric cardiac intensive care unit between 1 January 2023 and 1 January 2024. The cases were categorized into CCHD with prenatal follow-up (Group I), CCHD born without follow-up at our hospital (Group II), and CCHD accepted from external centers (Group III). Neonatal mortality and morbidity outcomes of these cases that underwent surgical or interventional procedures were statistically evaluated. Results: During the study period, there were 280 neonatal cases (50% male). Among these cases, 30% were in Group I (n = 84), 20% in Group II (n = 56), and 50% in Group III (n = 140). The cesarean section rate was higher in Group I compared to the other groups (80% vs. 52% vs. 45%), and the preoperative lactate levels were lower (0.9 vs. 1.7 vs. 2.1). The anatomical diagnoses, ventricular physiology, operation time, and interventional procedure time were similar. After interventional or surgical procedures, morbidity (22% vs. 25% vs. 36%) and mortality rates (6% vs. 9% vs. 18%) were lower in Group I and Group II compared to Group III. Conclusions: All infants diagnosed with CCHD before birth should be delivered in a tertiary heart center, which positively contributes to neonatal mortality and morbidity. More effort is needed to improve prenatal screening programs.
PMID:40564725 | PMC:PMC12191443 | DOI:10.3390/children12060767
Children (Basel). 2025 May 29;12(6):705. doi: 10.3390/children12060705.
ABSTRACT
OBJECTIVES: This study aimed to describe the prevalence of malnutrition and its impact on postoperative outcomes in infants and children with congenital heart diseases (CHDs) undergoing cardiac surgeries.
METHODS: We conducted a single-center, retrospective review of medical records of children aged 1 month to 5 years with CHDs who underwent cardiac surgery at the American University of Beirut Medical Center (AUBMC) between January 2015 and January 2017. Anthropometric data were collected and z-scores for weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and BMI-for-age were calculated. Malnutrition was classified based on the World Health Organization (WHO) definitions and the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. The postoperative outcomes were analyzed using bivariate and multivariable models.
RESULTS: The prevalence of malnutrition was 33.8%, with children younger than 24 months having significantly higher odds of malnutrition. The most common CHDs were ventricular septal defect (VSD) and tetralogy of Fallot (TOF), with malnutrition being significantly more prevalent in the children with VSD. Malnutrition was significantly associated with a prolonged pediatric intensive care unit (PICU) stay, with underweight being the strongest predictor. Malnourished children also had a significantly longer mechanical ventilation time (median 9.0 vs. 5.0 h, p = 0.017). Lower weight-for-age (WAZ) and BMI-for-age z-scores were associated with longer hospital stay, PICU stay, and mechanical ventilation durations.
CONCLUSIONS: Malnutrition is prevalent among children with CHDs and is independently associated with longer hospital and PICU stays, as well as extended mechanical ventilation. Early nutritional assessment and intervention may improve postoperative outcomes in this vulnerable population.
PMID:40564663 | PMC:PMC12191067 | DOI:10.3390/children12060705
Children (Basel). 2025 May 23;12(6):669. doi: 10.3390/children12060669.
ABSTRACT
Congenital heart disease (CHD), the most common congenital anomaly, remains a significant lifelong burden despite advancements in medical and surgical interventions. Induced pluripotent stem cells (iPSCs) have emerged as a groundbreaking platform in CHD research, offering patient-specific models to investigate the genetic, epigenetic, and molecular mechanisms driving the disease. Utilizing technologies such as CRISPR/Cas9 gene editing, cardiac organoids, and high-throughput screening, iPSCs enable innovative strategies in disease modeling, precision drug discovery, and regenerative therapies. However, clinical translation faces challenges related to immaturity, differentiation variability, large-scale feasibility, and tumorigenicity. Addressing these barriers will require standardized protocols, bioengineering solutions, and interdisciplinary collaboration. This review examines the critical role of iPSCs in advancing CHD research and care, demonstrating their potential to revolutionize treatment through patient-specific, regenerative approaches. By addressing current limitations and advancing iPSC technology, the field is positioned to pave the way for precision-based CHD therapies for this lifelong condition.
PMID:40564627 | PMC:PMC12190934 | DOI:10.3390/children12060669
Children (Basel). 2025 May 22;12(6):661. doi: 10.3390/children12060661.
ABSTRACT
Objective: To evaluate early and midterm outcomes of cryopreserved aortic homograft implantation in pediatric patients undergoing aortic valve and root replacement. Methods: A retrospective analysis was conducted on 36 pediatric patients aged 2 to 7 years who underwent cryopreserved aortic homograft implantation between January 2016 and December 2024. Indications included complex congenital aortic valve disease, annular hypoplasia, failed Ross procedure, and infective endocarditis. The standard root replacement technique was used under moderate hypothermic cardiopulmonary bypass. Postoperative outcomes were analyzed, including early complications, mortality, echocardiographic parameters, and long-term graft performance. Statistical analyses included the use of chi-square test, the Mann-Whitney U test, and Spearman correlation. Results: There was no 30-day mortality. One patient (2.8%) experienced late mortality at year 3, and two patients (5.6%) underwent reoperation at years 4 and 7 due to root aneurysm and severe regurgitation, respectively. Early postoperative echocardiography showed satisfactory hemodynamic performance with a mean gradient of 8.4 ± 3.2 mmHg. At 5-year follow-up, 92.9% of grafts maintained normal function. Conclusions: Cryopreserved homografts provide a safe and effective option for pediatric aortic valve replacement in the early and midterm period. However, potential late complications such as structural degeneration or root dilation necessitate long-term surveillance. Advances in decellularized grafts may improve future durability and integration.
PMID:40564621 | PMC:PMC12191320 | DOI:10.3390/children12060661
JACC Cardiovasc Interv. 2025 Jun 23;18(12):1526-1537. doi: 10.1016/j.jcin.2025.04.041.
ABSTRACT
BACKGROUND: Transcatheter patent foramen ovale (PFO) closure has become the gold-standard treatment for patients with cryptogenic embolism and PFO, but long-term outcomes data are limited.
OBJECTIVES: The aim of this study was to report the extended clinical outcomes of patients who underwent transcatheter PFO closure for cryptogenic embolism.
METHODS: PROLONG (PFO Transcatheter Occlusion Long-Term Outcomes National Group) is an investigator-initiated, multicenter, retrospective registry that enrolled patients who underwent transcatheter PFO closure between 1999 and 2013 at 12 centers in Italy. This analysis included only patients who underwent PFO closure for cryptogenic embolism, defined as cryptogenic ischemic stroke, transient ischemic attack, systemic embolism, or silent ischemic lesions on magnetic resonance imaging. Clinical, imaging, procedural, and follow-up data were collected from electronic health records and telephone interviews.
RESULTS: The study included 1,245 patients (mean age 47 ± 12 years, 56% women), with a mean follow-up duration of 14.5 ± 2.4 years. During follow-up, 34 patients (2.7%) experienced recurrent ischemic stroke, transient ischemic attack, or systemic embolism (0.19 per 100 patient-years). Predictors of recurrent events were Risk of Paradoxical Embolism (RoPE) score ≤ 7 (HR: 3.44; 95% CI: 1.06-11.3; P = 0.041), nonprobable PFO-Associated Stroke Causal Likelihood (PASCAL) classification (HR: 2.72; 95% CI: 1.17-6.34; P = 0.020), and new-onset atrial fibrillation (HR: 7.01; 95% CI: 2.45-20.1; P < 0.001). Serious complications were rare (0.4% in hospital, 0.4% during follow-up) and nonfatal.
CONCLUSIONS: This study confirms the long-term efficacy and safety of transcatheter PFO closure for patients with cryptogenic embolism and PFO in a real-world setting. (PFO Transcatheter Occlusion Long-Term Outcomes National Group [PROLONG] Registry; NCT06504121).
PMID:40562467 | DOI:10.1016/j.jcin.2025.04.041
Crit Care Explor. 2025 Jun 25;7(7):e1281. doi: 10.1097/CCE.0000000000001281. eCollection 2025 Jul 1.
ABSTRACT
OBJECTIVES: Acidemia frequently evolves in pediatric critical care patients, especially with congenital heart defects. Worsening acidemia secondary to inadequate systemic oxygen delivery can be detrimental to patients' outcomes and the ability to predict it has the potential to prompt early interventions to improve the clinical state. We aimed to evaluate the association of a novel near real-time predictive analytics algorithm with acidemia (ACD) (arterial pH < 7.25) in pediatric patients admitted to a critical care unit.
STUDY DESIGN: Retrospective observational study in nine tertiary institutions in the United States.
SETTING: Majority of patients were admitted to the cardiac ICU. Using Etiometry platform data (Etiometry, Boston, MA), acidemia (ACD) index was validated.
PATIENTS: Patients 12 years old or younger were admitted to an ICU between February 1, 2018, and November 31, 2020.
INTERVENTION: A total of 24,431 arterial blood pH measurements from 1858 patients were included in the validation dataset. The ACD index was calculated using a physiologic algorithm that incorporates patients' variables including laboratory and clinical data. Based on the previous assessment of the physiologic state of the patient, the physiologic algorithm interprets the new data in a real-time manner using Bayes' theorem.
MEASUREMENT AND MAIN RESULTS: Based on a complete dataset, the area under the receiver operating characteristic curve of the ACD index was 0.93. As the index value increased, the likelihood of having acidemia increased (p < 0.01). The relative risk of having acidemia when the ACD index is less than 1 was 0.11 (95% CI, 0.07-0.15), and the relative risk of not having acidemia when the ACD index was greater than 99 was 0.38 (95% CI, 0.32-0.46).
CONCLUSIONS: In this large pediatric cohort, higher ACD index values were associated with a higher likelihood of having acidemia. Consequently, this novel index has the potential to identify severe changes in clinical status. Prospective analysis of the ACD index is important to understand its utility in the management of pediatric critical illness.
PMID:40561190 | PMC:PMC12200221 | DOI:10.1097/CCE.0000000000001281
Eur Heart J Qual Care Clin Outcomes. 2025 Jun 25:qcaf052. doi: 10.1093/ehjqcco/qcaf052. Online ahead of print.
ABSTRACT
There is increasing recognition that social determinants of health affect outcomes in individuals with congenital heart disease and cause health disparities. This scientific statement from the European Association of Preventive Cardiology of the European Society of Cardiology provides an outline of the existing disparities from a global perspective in this population. We review the current knowledge on racial and ethnic patterns and the role of deprivation status, food insecurity, built environment, financial strain, psychological health and parental distress and education and literacy in creating inequities. Finally, we provide future directions for policy, research and clinical practice in achieving health equity in the congenital heart disease population.
PMID:40561137 | DOI:10.1093/ehjqcco/qcaf052
Spine Deform. 2025 Jun 25. doi: 10.1007/s43390-025-01132-w. Online ahead of print.
ABSTRACT
INTRODUCTION: Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT.
METHODS: A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2-5 days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications.
RESULTS: In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2-6 weeks post-operatively and one chylothorax that occurred 1 week post-operatively. Several clinically significant pleural effusions (4/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2-5 days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1).
CONCLUSION: This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10-11% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2-5 days resulted in no pulmonary complications.
PMID:40560514 | DOI:10.1007/s43390-025-01132-w