The role of pharmacogenomics and opioid prescribing for infants with surgical congenital heart disease.

ObjectivesThe occurrence of pulmonary infection after congenital heart disease (CHD) surgery can lead to significant increases in intensive care in cardiac intensive care unit (CICU) retention time, medical expenses, and risk of death risk. We hypothesized that patients with a high risk of pulmonary infection could be screened out as early after surgery. Hence, we developed and validated the first risk prediction model to verify our hypothesis.MethodsPatients who underwent CHD surgery from October 2012 to December 2017 in the Children’s Hospital of Chongqing Medical University were included in the development group, while patients who underwent CHD surgery from December 2017 to October 2018 were included in the validation group. The independent risk factors associated with pulmonary infection following CHD surgery were screened using univariable and multivariable logistic regression analyses. The corresponding nomogram prediction model was constructed according to the regression coefficients. Model discrimination was evaluated by the area under the receiver operating characteristic curve (ROC) (AUC), and model calibration was conducted with the Hosmer-Lemeshow test.ResultsThe univariate and multivariate logistic regression analyses identified the following six independent risk factors of pulmonary infection after cardiac surgery: age, weight, preoperative hospital stay, risk-adjusted classification for congenital heart surgery (RACHS)-1 score, cardiopulmonary bypass time and intraoperative blood transfusion. We established an individualized prediction model of pulmonary infection following cardiopulmonary bypass surgery for CHD in children. The model displayed accuracy and reliability and was evaluated by discrimination and calibration analyses. The AUCs for the development and validation groups were 0.900 and 0.908, respectively, and the P-values of the calibration tests were 0.999 and 0.452 respectively. Therefore, the predicted probability of the model was consistent with the actual probability.ConclusionsIdentified the independent risk factors of pulmonary infection after cardiopulmonary bypass surgery. An individualized prediction model was developed to evaluate the pulmonary infection of patients after surgery. For high-risk patients, after surgery, targeted interventions can reduce the risk of pulmonary infection.

Analysis of clinical and candidate genetic risk factors for postoperative atrial tachycardia after congenital heart surgery in infants

Background and ObjectivesSocioeconomic factors are associated with health outcomes and can affect postoperative length of stay after congenital heart disease (CHD) surgery. The hypothesis of this study is that patients from neighborhoods with a disadvantaged socioeconomic status (SES) have a prolonged length of hospital stay after CHD surgery.MethodsPre- and postoperative data were collected on patients who underwent CHD surgery at the University of Maryland Medical Center between 2011 and 2019. A neighborhood SES score was calculated for each patient using data from the United States Census Bureau and patients were grouped by high vs. low SES neighborhoods. The difference of patient length of stay (LOS) from the Society for Thoracic Surgeons median LOS for that surgery was the primary outcome measure. Linear regression was performed to examine the association between the difference from the median LOS and SES, as well as other third variables.ResultsThe difference from the median LOS was −4.8 vs. −2.2 days in high vs. low SES groups (p = 0.003). SES category was a significant predictor of LOS in unadjusted and adjusted regression analyses. There was a significant interaction between Norwood operation and SES—patients with a low neighborhood SES who underwent Norwood operation had a longer LOS, but there was no difference in LOS by SES in patients who underwent other operations.ConclusionsNeighborhood SES is a significant predictor of the LOS after congenital heart disease surgery. This effect was seen primarily in patients undergoing Norwood operation.

BackgroundAcute kidney injury (AKI) is a commonly recognized clinical problem after congenital heart disease (CHD) surgery. Increased perioperative morbidity, development of chronic kidney disease, and increased mortality are the major concerns. We investigated frequency, risk factors, and outcomes of AKI after CHD surgery at our hospital.MethodsThis study was a retrospective analytic review conducted from January 2013 to October 2016 on patients aged between 1 month and 45 years who underwent cardiopulmonary bypass (CPB) for CHD surgery. The modified Kidney Disease Improving Global Outcomes criteria based on serum creatinine value was adopted to diagnose AKI. We assessed AKI frequency and its staging, and outcomes as AKI resolution, length of stay, and mortality. Stages II and III (plasma creatinine level two or more times the baseline) were labeled as severe AKI. Univariate and multivariate logistic regression analyses were conducted, and results were reported as mean with standard deviation and as frequencies with percentage. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported for factors associated with the development of AKI.ResultsOf the 840 patients who underwent CHD surgery, 237 (28%) developed AKI. AKI stages II1 and III were seen in 101 (42%) and 103 (43%) patients, respectively. Prolonged CPB time > 120 minutes (adjusted OR [AOR]: 1.87; 95% CI: 1.22-2.88; p = 0.004) and hemoglobin > 16 gm/dL (AOR: 1.80; 95% CI: 1.16-2.78; p = 0.008) were associated with the development of AKI on multivariate analysis. AKI resolved spontaneously in 222 (94%) patients, and 10 (4%) patients who developed AKI died.ConclusionsMost patients with AKI showed spontaneous resolution. Prolonged CPB time and increased hemoglobin were found to be significant risk factors. Our study found spontaneous resolution of AKI in most cases. However, preplanning and careful monitoring in patients with expected prolonged CPB time and increased baseline hemoglobin can prevent and identify AKI at an early stage.

Objective To explore the risk factors of puncture- or catheter-related lower extremity venous thrombosis after surgery for congenital heart disease(CHD). Methods A retrospective analysis was performed on 683 children with venipuncture or venous catheterization in the lower extremities who underwent surgery for CHD in Children′s Heart Center Intensive Care Unit, Henan Provincial People′s Hospital from January 2017 to December 2018, and there were 55 children suspected thrombosis, among whom, 26 cases of thrombosis confirmed by ultrasound were included in the thrombosis group, and 29 cases without thrombosis seen by ultrasound were assigned to the control group.A comparative analysis was carried out to see whether there were statistical differences in the possible risk factors between the 2 groups, and the risk factors of puncture- or catheter-related lower extremity venous thrombosis after operation of CHD. Results The incidence of puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD was 3.81% (26/683 cases). The differences between the thrombosis group and the control group in age (62 d vs.92 d), weight [(3.92±0.66) kg vs.(4.61±0.86) kg], CHD postoperative critical score (Vasoactive-Ventilation-Renal score, VVR)[(29.58±15.50) scores vs.(22.14±11.72) scores], peak blood lactate within 24 hours after surgery [(3.59±0.66) mmol/L vs.(1.71±1.13) mmol/L], postoperative blood transfusion[76.9%(20/26 cases) vs.34.5%(10/29 cases)], co-infection[53.8%(14/26 cases) vs.24.1%(7/29 cases)], cyanotic congenital heart disease [84.6%(22/26 cases) vs.34.5%(10/29 cases)] and puncture difficulty[69.2%(18/26 cases) vs.17.2%(5/29 cases)] were statistically significant(all P<0.05). Logistic regression analysis showed postoperative VVR score (OR=0.88, 95%CI: 0.77-0.99, P=0.04), blood lactate peak within 24 hours after surgery (OR=6.62, 95%CI: 1.35-32.46, P=0.02), and cyanotic congenital heart disease (OR=0.04, 95%CI: 0.00-0.63, P=0.04) were risk factors for venous thrombosis in the lower extremities. Conclusions High postoperative VVR score, high 24 h blood lactate peak after surgery and cyanotic congenital heart disease are high risk factors for puncture- or catheter-related lower extremity venous thrombosis after surgery for CHD. Key words: Congenital heart disease; Lower extremity vein; Thrombosis; Infant

BackgroundThirst is a prevalent and intense symptom experienced in children after congenital heart disease (CHD) surgery. Identifying independent risk factors for thirst is crucial for early prevention and management. This study aimed to investigate the incidence, severity, and influencing factors of thirst in children after CHD surgery.MethodsThis cross-sectional study included 153 children who underwent CHD surgery at a tertiary hospital in Fujian Province between December 2023 and April 2024. The incidence, severity, and distribution characteristics of thirst were assessed using the NRS score. The multiple linear regression analysis was utilized to identify the factors influencing thirst.ResultsThe incidence of thirst was 93.5%, with 5.2% of participants experiencing mild thirst, 9.8% experiencing moderate thirst, and 78.4% experiencing severe thirst. Univariate analysis indicated that the use of diuretics and opioids, blood sodium levels, cardiopulmonary bypass (CPB) time, duration of mechanical ventilation, length of water fasting, and both the APACHE-II and mYPAS scores were significant factors influencing postoperative thirst. Furthermore, multivariate linear regression analysis identified CPB time, duration of mechanical ventilation, length of water fasting, APACHE-II score, and mYPAS score as independent predictors of postoperative thirst.ConclusionsThe prevalence of thirst among children after CHD surgery was notably high and severe. CPB time, duration of mechanical ventilation, length of water fasting, APACHE-II score, and mYPAS independently influence the severity of thirst. Healthcare professionals should proactively assess the severity of thirst, incorporate the identified influencing factors into the development of targeted thirst management protocols, and initiate timely interventions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06012-w.

The changing demographics of the adult congenital heart disease (CHD) population requires an understanding of the factors that impact patient survival to adulthood. We sought to investigate sex differences in CHD surgical mortality in children. Children <18 years old hospitalized for CHD surgery were identified using the Kids' Inpatient Database in 2000, 2003, and 2006. Demographic, diagnostic, and procedural variables were grouped according to RACHS-1 (Risk Adjustment for Congenital Heart Surgery) method. Logistic regression was used to determine the odds ratio of death in females versus males adjusting for RACHS-1 risk category, age, prematurity, major noncardiac anomalies, and multiple procedures. Analyses were stratified by RACHS-1 risk categories and age. Of 33 848 hospitalizations for CHD surgery, 54.7% were in males. Males were more likely than females to have CHD surgery in infancy, high-risk CHD surgery, and multiple CHD procedures. Females had more major noncardiac structural anomalies and more low-risk procedures. However, the adjusted risk of in-hospital death was higher in females (odds ratio, 1.21; 95% confidence interval, 1.08 to 1.36) on account of the subgroup with high-risk surgeries who were <1 year of age (odds ratio, 1.39; 95% confidence interval, 1.16 to 1.67). In this large US population study, more male children underwent CHD surgery and had high-risk procedures. Female infants who had high-risk procedures were at higher risk for death, but this accounted for a small proportion of females and is therefore unlikely to have a major impact on the changing demographics in adults in CHD.

ObjectiveCardiac biomarkers are widely used to evaluate postoperative myocardial injury, but studies on their relationship with cardiac function in pediatrics are limited. This study aimed to characterize the dynamic changes of cardiac biomarkers after congenital heart disease (CHD) surgery in patients aged 0–3 years and assess their correlation with cardiac function.MethodsWe retrospectively enrolled 63 pediatric patients (0–3 years) who underwent CHD surgery at Zhongnan Hospital between January 2021 and June 2024. Biomarkers and left ventricular ejection fraction (LVEF) were measured preoperatively and postoperatively within 1 week. The associations between the biomarkers and LVEF were analyzed. Receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of the biomarkers for cardiac dysfunction, composite complications, and early mortality.ResultsBiomarker levels peaked on postoperative day (POD) 1 and declined to near-baseline levels within 1 week. LVEF decreased initially and then gradually recovered to near preoperative levels by POD 4–7. LVEF on POD 1 negatively correlated with the peak high-sensitivity troponin I (hs-TnI) and creatine kinase–MB (CK-MB) levels. The ROC analysis showed that hs-TnI and CK-MB had good predictive power for cardiac dysfunction (AUC = 0.818 and 0.828) and composite complications (AUC = 0.736 and 0.745), but limited value for early mortality (AUC = 0.665).ConclusionHs-TnI and CK-MB are key biomarkers that reflect the relationship between myocardial injury and cardiac function recovery after CHD surgery in pediatric patients aged 0–3 years. Their peak postoperative levels can predict cardiac function recovery and composite complications.

Objective: This study aimed to evaluate the effectiveness of flexible bronchoscopy (FB)-assisted extubation compared to conventional extubation strategies in managing extubation failure (EF) in infants after congenital heart disease (CHD) surgery. Methods: A historical control study included 95 infants who underwent CHD surgery between May 2021 and May 2023. Patients were divided into two groups based on the postoperative extubation management strategy: the conventional weaning (CW) group (n=45) received management without FB assistance to prevent EF, and the FB group (n = 50), where FB was actively utilized to facilitate extubation. Results: The FB group demonstrated a significantly lower reintubation rate than the CW group (4% vs. 18%, p = 0.043). Additionally, the FB group exhibited shorter durations of mechanical ventilation, noninvasive ventilation (NIV), and hospital stays (p &lt; 0.05). No significant differences between groups in EF rates (14% vs. 18%, p = 0.779) or extubation-related complications were observed. Findings relating to FB-assisted extubation identified subglottic stenosis, airway granulation, and mucus plug obstruction as common contributors to EF, facilitating targeted interventions. Conclusions: FB-assisted extubation may reduce reintubation rates and hospital stays in infants after CHD surgery without increasing complication risks; however, further studies are needed to validate these findings.

Dexmedetomidine decreases cardiac complications in adults undergoing cardiovascular surgery. This systematic review assessed whether perioperative dexmedetomidine improves congenital heart disease (CHD) surgery outcomes in children. The PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) or observational studies that were published until 16 April 2015 and compared dexmedetomidine with placebo or an alternative anesthetic agent during pediatric CHD surgery. The assessed outcomes included hemodynamics, ventilation length, intensive care unit (ICU) and hospital stays, blood glucose and serum cortisol levels, postoperative analgesia requirements, and postoperative delirium. Five RCTs and nine observational studies involving 2229 patients were included. In pooled analyses, dexmedetomidine was associated with shorter length of mechanical ventilation (mean difference: -93.36, 95% CI: -137.45, -49.27), lower postoperative fentanyl (mean difference: -24.11, 95% CI: -36.98, -11.24) and morphine (mean difference: -0.07, 95% CI: -0.14, 0.00) requirements, reduced stress response (i.e., lower blood glucose and serum cortisol levels), and lower risk of delirium (OR: 0.39, 95% CI: 0.21, 0.74). The hemodynamics of dexmedetomidine-treated patients appeared more stable, but there were no significant differences in the ICU or hospital stay durations. Dexmedetomidine may increase the bradycardia and hypotension risk (OR: 3.14, 95% CI: 1.47, 6.69). Current evidence indicates that dexmedetomidine improves outcomes in children undergoing CHD surgery. However, this finding largely relies on data from observational studies; high-quality RCTs are warranted because of the potential for subject selection bias.

Opioid-Related Pharmacogenomic Variants in a Retrospective Cohort of High-Risk Hospitalized Infants.

Factors Associated With Gastrostomy Tube Complications in Infants With Congenital Heart Disease

Introduction: Atrial tachycardia (AT) after infant congenital heart disease (CHD) surgery has been associated with increased mortality. Common genetic variants in PITX2 (rs2200733) and IL6 (rs1800795) have been associated with post-operative AT in adults, but have not been studied in infants after CHD surgery. Hypothesis: Genetic variants in PITX2 and IL6 are associated with post-operative AT in infants with CHD. Methods: Children less than 1 year of age undergoing their first CHD surgery at our center between 9/2007 and 3/2014 who consented to the study were included. Subjects provided a DNA sample and had repeated daily assessment of telemetry with documentation of all arrhythmias and clinical variables. Genotyping was performed in the Vanderbilt genomics core lab using the TaqMan PCR Core Reagent Kit. Children with and without AT were compared using chi-square or unpaired t-test as appropriate. Results: Of 923 enrolled infants, 141 had post-operative AT (15.3%), 79 of who required treatment (8.6%). AT was associated with increased mortality (12.1% mortality with AT; vs. 5.5% no AT, P = 0.004), longer hospital stay (mean of 49 days with AT; vs. 23 days no AT, P &lt; 0.0001), intensive care unit (ICU) stay (mean of 34 days with AT; vs.13 days no AT, P &lt; 0.0001), and mechanical ventilation duration (mean of 22 days with AT; vs. 8 days no AT, P &lt; 0.0001). Age, epinephrine use, milrinone use, bypass time, cross-clamp time, lactate, and number of pump runs were associated with AT and AT requiring treatment. PITX2 and IL6 genotypes were not significantly associated with AT or AT requiring treatment. Conclusions: AT is associated with increased mortality and longer hospital stay, ICU stay, and mechanical ventilation duration. Numerous operative factors contribute to AT after infant CHD surgery. PITX2 and IL6 genetic variants were not found to be significantly associated with post-operative AT in infants undergoing CHD surgery in our study.

Adult Congenital Heart Surgery: Adult or Pediatric Facility? Adult or Pediatric Surgeon?

Clinical predictors of permanent injury to the atrioventricular conduction system after congenital heart disease surgery. A new perspective on an old problem