Is Surgery for Congenital Heart Defects in Neonates, Infants, and Children More Challenging and Demanding Than Surgery for Acquired Heart Defects in Adults?

Pediatric cardiac surgery presents unique challenges due to the complexity of congenital heart defects (CHD), requiring highly specialized techniques, individualized interventions, and long-term patient care. Unlike adult cardiac surgery, which addresses standardized conditions, CHD surgery demands precision, adaptability, and multidisciplinary expertise. Limited cardiovascular reserves in younger patients increase surgical risks. Addressing global disparities in pediatric cardiac care is crucial for improving outcomes.

March 5, 2025

Lethal Myocardial Infarction in a Neonate During Extracorporeal Membrane Oxygenation

This case study explores a neonate with congenital diaphragmatic hernia (CDH) who experienced a lethal myocardial infarction (MI) while on extracorporeal membrane oxygenation (ECMO). The patient developed a large thrombus extending from the arterial cannula into the left main coronary artery, leading to severe cardiac dysfunction. Despite anticoagulation efforts, the clot progressed, resulting in a fatal outcome. The study highlights the challenges of managing neonatal ECMO and intracardiac thrombosis.

March 4, 2025

Pulmonary Artery Systolic Pressure Associated with Inflammatory Factors Among Pediatric Congenital Heart Disease with Pulmonary Arterial Hypertension After Cardiopulmonary Bypass

This study investigates the relationship between pulmonary artery systolic pressure (PASP) and inflammatory factors in pediatric congenital heart disease (CHD) patients with pulmonary arterial hypertension (PAH) after cardiopulmonary bypass (CPB). The study found that elevated preoperative PASP correlates with increased postoperative inflammatory cytokines, particularly IL-6 and IL-10. Higher PASP (>52 mmHg) predicted prolonged ventilation time (>21 hours), suggesting worsened postoperative outcomes.

March 3, 2025

Neurodevelopmental Outcomes After Nitric Oxide During Cardiopulmonary Bypass for Open Heart Surgery: A Randomized Clinical Trial

This randomized clinical trial examined whether nitric oxide (NO) administered during cardiopulmonary bypass (CPB) improves neurodevelopmental and health-related quality of life (HRQOL) outcomes in infants undergoing open heart surgery. Conducted across six centers, the study followed 927 infants at 12 months post-surgery. Results showed no significant differences in neurodevelopment or HRQOL between the NO and standard CPB groups, suggesting NO does not enhance long-term neurological outcomes.

February 8, 2025

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot

This retrospective cohort study compared pulmonary valve-sparing and transannular patch techniques for correcting Tetralogy of Fallot (ToF) in 102 pediatric patients. The study found that the valve-sparing approach led to shorter durations of mechanical ventilation, ICU stays, and hospitalization, with fewer complications like arrhythmias. However, transannular patch patients had higher rates of severe pulmonary regurgitation. Weight was identified as an independent predictor of ventilation duration.

December 12, 2024

Center Volume and Survival in Inter-Hospital Transfers for Pediatric Cardiac Surgery: No Significant Association

This study analyzed 25,749 pediatric cardiac surgery cases requiring cardiopulmonary bypass (CPB) using the Kids’ Inpatient Database (2016 and 2019) to evaluate whether hospital case volume impacts inpatient mortality for transferred patients. Among 3,511 transferred patients, unadjusted mortality was higher than for direct admissions across low-, mid-, and high-volume centers. However, risk-adjusted inpatient mortality showed no significant differences based on hospital volume, even for high-complexity cases. The findings suggest that transfer decisions should not rely solely on annual case volume.

December 1, 2024

Hyperlactataemia Following Crystalloid Cardiopulmonary Bypass Priming in Paediatric Cardiac Surgery: Benign or Malignant?

This retrospective study examined paediatric patients undergoing cardiac surgery with crystalloid priming to evaluate outcomes related to postoperative hyperlactataemia. Among 186 patients, 53% experienced hyperlactataemia, which was associated with longer cardiopulmonary bypass and ICU stays but did not increase ventilation duration. Findings suggest transient hyperlactataemia may not indicate tissue hypoxaemia, but longer inotropic support and ICU stays necessitate careful management post-surgery.

November 28, 2024

Standardized Therapies After ECMO Program (STEP): A Novel Approach to Pediatric Post-ECMO Care

This study evaluated the effectiveness of the Standardized Therapy after ECMO Program (STEP), a structured discharge pathway for pediatric ECMO survivors. It compared compliance with post-ECMO care guidelines before and after STEP implementation in a U.S. pediatric hospital. After STEP, compliance increased for neurodevelopmental testing, neurology and audiology evaluations, and referrals for therapy services. The program significantly improved both inpatient and outpatient follow-up, ensuring comprehensive post-ECMO care.

September 27, 2024

Outcomes in Patients Who Received ECMO and/or Volatile Anesthetics as Rescue Therapies for Status Asthmaticus

This study explores the outcomes of pediatric patients with status asthmaticus (SA) who received either inhaled volatile anesthetics (IVA), extracorporeal membrane oxygenation (ECMO), or both as rescue therapies in a PICU setting. Among seven patients, most who received IVA were escalated to ECMO. The results suggest that early ECMO cannulation might be beneficial, though larger studies are needed to form conclusive guidelines for SA management in critically ill children.

September 21, 2024

Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

This case report discusses the challenges of managing cardiopulmonary bypass (CPB) in an 8-month-old pediatric patient with factor XII deficiency, a rare coagulopathy that complicates anticoagulation monitoring. The use of the Hemochron Signature Elite with ACT+ cartridges provided reliable anticoagulation monitoring during surgery. The report reviews current strategies for managing CPB in patients with this condition, highlighting the importance of specialized tools for predictable results.

September 21, 2024

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Category: Pediatric

Is Surgery for Congenital Heart Defects in Neonates, Infants, and Children More Challenging and Demanding Than Surgery for Acquired Heart Defects in Adults?

Lethal Myocardial Infarction in a Neonate During Extracorporeal Membrane Oxygenation

Pulmonary Artery Systolic Pressure Associated with Inflammatory Factors Among Pediatric Congenital Heart Disease with Pulmonary Arterial Hypertension After Cardiopulmonary Bypass

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot

Center Volume and Survival in Inter-Hospital Transfers for Pediatric Cardiac Surgery: No Significant Association

Hyperlactataemia Following Crystalloid Cardiopulmonary Bypass Priming in Paediatric Cardiac Surgery: Benign or Malignant?

Standardized Therapies After ECMO Program (STEP): A Novel Approach to Pediatric Post-ECMO Care

Outcomes in Patients Who Received ECMO and/or Volatile Anesthetics as Rescue Therapies for Status Asthmaticus

Cardiopulmonary Bypass in a Pediatric Patient with Factor XII Deficiency

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