Cardiac Surgical Intervention Research Articles

Outcomes of Transcatheter Aortic Valve Implantation in Patients with and without Diabetes Mellitus.

Diabetes mellitus (DM) in patients undergoing cardiac transcatheter or surgical interventions usually is correlated with poor outcomes. Transcatheter aortic valve implantation (TAVI) has been developed as a therapy choice for inoperable, high-, or intermediate-risk surgical patients with severe aortic stenosis (AS). To evaluate the impact of DM and hemoglobin A1c (HbA1c) on outcomes and survival after TAVI. Five hundred and fifty-two symptomatic severe AS patients who underwent TAVI, of whom 164 (29.7%) had DM, were included in this retrospective study. Follow-up was performed after 30 days, six months, and annually. The device success and risks of procedural-related complications were similar between patients with and without DM, except for acute kidney injury, which was more frequent in the DM group (2.4% vs. 0%, P=0.021). In-hospital and first-year mortality were similar between the groups (4.9% vs. 3.6%, P=0.490 and 15.0% vs. 11.2%, P=0.282, respectively). There was a statistical difference between HbA1c ≥ 6.5 and HbA1c ≤ 6.49 groups in total mortality (34.4% vs. 15.8%, P<0.001, respectively). The only independent predictors were Society of Thoracic Surgeons score (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.09-1.51; P=0.003) and HbA1c level ≥ 6.5 (HR 10.78, 95% CI 2.58-21.50; P=0.003) in multivariable logistic regression analysis. In this study, we conclude that DM was not correlated with an increased mortality risk or complication rates after TAVI. Also, it was shown that mortality was higher in patients with HbA1c ≥ 6.5, and it was an independent predictor for long-term mortality.

Evaluation of Outcomes in Patients with Previous Stroke History following Cardiac Surgery: A Single-Center Study.

Background: The aim of the study to analyze the risk of complications, including neurological sequelae, alongside early and late mortality among patients with antecedent stroke subjected to cardiac surgical interventions with extracorporeal support. Material and methods: A single-center retrospective study was conducted on 10,685 patients who underwent cardiac surgery with extracorporeal circulation at the Department of Cardiac Surgery. The first group comprised all patients eligible for cardiac surgery with extracorporeal circulation. The second group consisted of patients with a preoperative history of stroke. Results: In the study, a statistically significant association was observed between preoperative stroke and the occurrence of postoperative pneumonia (OR = 1.482, p = 0.006), respiratory failure (OR = 1.497, p = 0.006), renal failure (OR = 1.391, p = 0.019), 30-day mortality (OR = 1.528, p = 0.026), 90-day mortality (OR = 1.658, p < 0.001), and one-year mortality (OR = 1.706, p < 0.001). Conclusions: Patients with a history of preoperative stroke more frequently experienced renal failure and respiratory-system complications such as pneumonia and respiratory failure. The survival time of patients with a history of preoperative stroke was shorter compared to that of the control group during the analyzed 30-day, 90-day, and one-year observation periods.

Apical hypertrophic cardiomyopathy

The review provides information about apical hypertrophic cardiomyopathy (HCM), which is a relatively rare phonotype of HCM. Previously, it was believed that apical HCMP has a favorable prognosis, but recent studies have demonstrated an increased risk of fatal arrhythmias and sudden cardiac death, especially among elderly patients, women and those with comorbidities such as arterial hypertension and diabetes mellitus. Patients with apical HCMP complain of chest pain, shortness of breath and palpitations. The diagnosis is based on data from various investigation methods, among which imaging techniques such as echocardiography and cardiac magnetic resonance imaging are crucial. For apical HCMP, a characteristic sign is the identification of the configuration of the left ventricular cavity at the end of the systole resembling to the type "Ace-of-spades". Treatment includes pharmacotherapy using beta-blockers, calcium channel blockers, cardiac myosin inhibitors and surgical interventions. The lack of information on unfavorable prognostic factors, the lack of specific clinical data and the complexity of instrumental diagnosis emphasize the relevance of studying the problem of apical HCMP.

Safety and efficacy of percutaneous lead extraction of infected cardiac electronic devices: a single-center study

Abstract Funding Acknowledgements None. Background Infections of implanted cardiac electronic devices (CIEDs) are associated with increased morbidity and mortality. Current guidelines recommend either percutaneous or surgical lead removal. Purpose To assess and document the safety and efficacy of percutaneous lead extraction within our Electrophysiology (EP) Lab over the past 2 years. Methods We enrolled consecutive patients with CIED-related infections who underwent percutaneous lead extractions at our EP lab. Results A total of 26 consecutive patients were included in the study, of whom 21 (81%) were males, with a median age of 67 years. Among these patients, 9 (35%) had permanent pacemakers, 11 (42%) had implantable defibrillator systems, and 6 (23%) had biventricular defibrillator systems. Device extrusion was observed in 17 patients (65%), while the remaining 9 (35%) had lead vegetations. Among the 17 patients with device extrusion, 3 (18%) also had lead vegetations, but only 2 (12%) had positive blood cultures. Among the 9 patients without device extrusion, 5 (56%) had vegetations in the leads and tricuspid valve, while 4 (44%) had positive blood cultures. The mean duration from CIED implantation to infection was 81.5 months. Percutaneous lead extraction of CIEDs was successful in 25 patients (96%) using transvenous rotational dilators and endovascular lead extraction tools. In one patient, femoral access with a snare was required for lead retrieval. In another case, where complete lead removal was necessary, the patient developed a massive pulmonary embolism, leading to surgical removal. Additionally, in one patient with a 20-year-old permanent pacemaker, lead extraction was not successful; however, surgical removal was avoided due to the high risk involved. Conclusions The use of transvenous rotational dilators and endovascular lead extraction tools for transvenous removal of CIEDs due to extrusion and/or endocarditis is safe and highly effective, avoiding high-risk cardiac surgical interventions.

Correlation between pressure gradient from echocardiography and peak-to-peak pressure gradient from cardiac catheterization or surgery in patients with coarctation of aorta.

The gold standard for assessing pressure gradients (PG) across coarctation involves measurements obtained through cardiac catheterization or surgical intervention. There has been ongoing discussion regarding the accuracy of non-invasive methods for estimating these gradients. This study sought to establish the correlation and agreement between the systolic blood pressure (SBP) gradient between the upper and lower extremities, as well as, the mean and maximum PG derived from echocardiography, in comparison to the peak-to-peak pressure gradient obtained from either cardiac catheterization or surgery. We conducted a retrospective study on patients < 18 years diagnosed with coarctation at Chiang Mai University Hospital from 2011 to 2022. The study involved the measurement of the SBP gradient between the upper and lower extremities, mean and maximum PG using echocardiography, peak-to-peak pressure gradient obtained from cardiac catheterization, and pressure gradient recorded during surgical procedures. The Spearman's correlation and Bland-Altman analysis were employed to assess correlation and agreement. Fifty-four patients with aortic coarctation were enrolled. The mean PG measured by echocardiography showed a significantly moderate correlation (r = 0.78, p < 0.001) and the highest level of agreement according to Bland Altman plots, in comparison to the peak-to-peak pressure gradient measured during both cardiac catheterization and surgical procedure. The max PG demonstrated a notable overestimation compared to the gold standard (mean difference + 13.14 with a slope of biases + 0.64, p < 0.001). The mean PG obtained through echocardiography has more potential to be applied in practical application in predicting pressure gradient in patients with coarctation.

Correction to: Timing of Cardiac Surgical Interventions and Postoperative Mortality in Children With Severe Congenital Heart Defects Across Europe: Data From the EUROlinkCAT Study.

Correction to: Timing of Cardiac Surgical Interventions and Postoperative Mortality in Children With Severe Congenital Heart Defects Across Europe: Data From the EUROlinkCAT Study.

Extracardial pathology as an additional risk factor in the correction of congenital heart defects in children

Introduction. Concomitant diseases as a risk factor for surgery remain an urgent problem in pediatric cardiac surgery. The article presents the role of comorbidity in pediatric cardiac surgery. A comparative analysis of the indicators of cardiac surgical treatment of patients with and without extracardiac pathology was carried out. Aim: to determine the significance of extracardiac causes as an additional risk factor in the correction of congenital heart lesions in children. &#x0D; Materials and methods. Prospective analysis of five hundred patients who had undergone cardiac surgery in the departments of cardiac surgery and interventional cardiology. Patients were divided into a main group of patients with concomitant pathology &#x0D; (n = 350) and a control group (n = 150) without concomitant pathology. A complex of modern therapeutic and diagnostic procedures and a multidisciplinary approach were used. &#x0D; Results. A high incidence of complications was shown in the main group (70%). Hospital mortality was higher in patients with concomitant pathology and amounted to 17.4%, compared to 3.3% in the group without concomitant pathology. The average duration in the ICU for patients with concomitant pathology was 18 ± 2 bed days, for patients without concomitant pathology — 4 ± 2 bed days. &#x0D; Conclusion. The presence of concomitant pathology has been shown to influence significantly on the development of complications and be a prognostic risk factor that must be included in modern prediction models.

ЗНАЧЕНИЕ ИММУНОЛОГИЧЕСКОГО СКРИНИНГА В ПРОГНОЗИРОВАНИИ ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ КАРДИОХИРУРГИИ

Incidence of infectious complications in children with congenital heart disease, especially with cyanotic and complex defects, is higher than in the population, which is associated with both hemodynamic and immune disorders. Various types of primary immunodeficiencies in congenital heart disease and the dependence of immune disorders on the morphology of the defect, the severity of circulatory failure and arterial hypoxemia are described. The importance of diagnosing immunological disorders is emphasized to reduce the risk of infectious complications of cardiac surgery, reduce mortality and improve the outcomes of surgical interventions for congenital heart disease. The prognostic value of immune disorders identified by the TREC/KREC method for infectious complications of cardiac surgery has not been studied. The purpose of this research was to assess the possibility of predicting infectious complications of cardiac surgery in children with congenital heart disease based on screening using the TREC/KREC method. Material and methods used: preoperatively, 200 children with congenital heart disease aged 3 days to 12 months old were examined. Instrumental and laboratory methods were used including immunological screening for TREC/KREC DNA. Results: 123 (62.4%) were diagnosed with “acyanotic” congenital heart disease, 74 (37.5%) with various cyanotic congenital heart diseases and 10 (5%) with congenital heart diseases with Down syndrome, Di George syndrome, Williams syndrome or multiple malformations. 184 (92%) underwent various cardiac surgical interventions. Violations of T-cell immunity according to preoperative TREC/KREC screening were observed in 23.5% of cases including in all children with syndromic forms of congenital heart disease, multiple malformations, and significantly more often in cyanotic congenital heart disease, conotruncal defects, and those admitted in critical conditions. Infectious complications of cardiac surgery were observed significantly more often in this group than in children with normal T-cell immunity (in 36% and 3.6%, respectively). Conclusion: the prognostic value of TREC/KREC screening for targeted preparation and postoperative management in order to prevent infectious complications of cardiac surgery has been confirmed.

Fetomaternal outcomes in pregnant women with congenital heart disease: a comparative analysis from an apex institute.

With advancements in cardiac surgical interventions during infancy and childhood, the incidence of maternal congenital heart disease (CHD) is increasing. This retrospective study compared fetal and cardiac outcomes in women with and without CHD, along with a sub-analysis between cyanotic versus non-cyanotic defects and operated versus non-operated cases. A 10-year data were retrospectively collected from pregnant women with CHD and a 1:1 ratio of pregnant women without any heart disease. Adverse fetal and cardiac outcomes were noted in both groups. Statistical significance was set at P<0.05. A total of 86 pregnant women with CHD were studied, with atrial septal defects (29.06%) being the most common. Out of 86 participants, 27 (31.39%) had cyanotic CHD. Around 55% of cases were already operated on for their cardiac defects. Among cardiovascular complications, 5.8% suffered from heart failure, 7.0% had pulmonary arterial hypertension, 8.1% presented in New York Heart Association functional class IV, 9.3% had a need for intensive care unit admission, and one experienced maternal mortality. Adverse fetal outcomes, including operative vaginal delivery, mean duration of hospital stay, fetal growth restriction, preterm birth (<37 weeks), low birth weight (<2,500 g), 5-minute APGAR score <7, and neonatal intensive care unit admissions, were significantly higher in women with CHD than in women without heart disease. Women with CHD have a higher risk of adverse fetal and cardiac outcomes. The outcome can be improved with proper pre-conceptional optimization of the cardiac condition, good antenatal care, and multidisciplinary team management.

Heart Failure Nurses within the Primary Care Setting.

Cardiology services within primary care often focus on disease prevention, early identification of illness and prompt referral for diagnosis and specialist treatment. Due to advances in pharmaceuticals, implantable cardiac devices and surgical interventions, individuals with heart failure are living longer, which can place a significant strain on global healthcare resources. Heart failure nurses in a primary care setting offer a wealth of clinical knowledge and expertise across all phases of the heart failure trajectory and are able to support patients, family members and other community services, including general practitioners. This review examines the recently published evidence on the current and potential future practice of heart failure nurses within primary care.

Right atrial myxoma in a paediatric patient with inflammatory bowel disease – a case report

Background: Cardiac myxoma is the most common primary cancer of the heart in adults. It is characterised by non-specific clinical symptoms and radiological findings. The aim of this study is to present the case of a 3.5-year-old boy diagnosed with right atrial myxoma briefly after the onset of inflammatory bowel disease treatment. Case report: The patient was hospitalised because of chronic diarrhoea, dyselectrolytaemia, and severe cachexia. Following multiple examinations, a diagnosis of inflammatory bowel disease was made. Additionally, due to upper limb oedema, a cardiac consultation and echocardiography were conducted, revealing a solid mass in the right atrium. Consequently, a cardiac surgical intervention was carried out due to the patient’s condition. Conclusions: Right atrial myxomas are extremely rare in paediatric patients, and the coexistence of inflammatory bowel disease and cardiac myxoma has not been previously reported in the literature. Further research is needed to establish the potential correlation between these two diseases.

Timing of Cardiac Surgical Interventions and Postoperative Mortality in Children With Severe Congenital Heart Defects Across Europe: Data From the EUROlinkCAT Study.

The purpose of this study was to evaluate the timing of the first cardiac surgery, the number of cardiac surgeries performed, and 30-day postoperative mortality rate for children with severe congenital heart defects (sCHDs) in their first 5 years of life. This was a population-based data linkage cohort study linking information from 9 European congenital anomaly registries to vital statistics and hospital databases. Data were extracted for 5693 children with sCHDs born from 1995 to 2004. Subgroup analyses were performed for specific types of sCHD. Children with sCHDs underwent their first surgical intervention at a median age of 3.6 (95% CI, 2.6-4.5) weeks. The timing of the first surgery for most subtypes of sCHD was consistent across Europe. In the first 5 years of life, children with hypoplastic left heart underwent the most cardiac surgeries, with a median of 4.4 (95% CI, 3.1-5.6). The 30-day postoperative mortality rate in children aged <1 year ranged from 1.1% (95% CI, 0.5%-2.1%) for tetralogy of Fallot to 23% (95% CI, 12%-37%) for Ebstein anomaly. The 30-day postoperative mortality rate was highest for children undergoing surgery in the first month of life. Overall 5-year survival for sCHD was <90% for all sCHDs, except transposition of the great arteries, tetralogy of Fallot, and coarctation of the aorta. There were no major differences among the 9 regions in the timing, 30-day postoperative mortality rate, and number of operations performed for sCHD. Despite an overall good prognosis for most congenital heart defects, some lesions were still associated with substantial postoperative death.

Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach

The aim of this article is to present the importance of astructured and situation-adapted approach based on the diagnostic and therapeutic strategy in the interdisciplinary treatment of 54patients with deep sternal wound infections (DSWI) after cardiac surgical interventions and the results achieved. The patients were 41men and 13women with an average age of 65.1years, who developed aDSWI after acardiac surgical intervention during the period 2003-2016. The treatment strategy included athorough debridement including the removal of indwelling foreign material, the reconstruction with astable re-osteosynthesis after overcoming the infection and if necessary, situation-related surgical flaps for adefect coverage with agood blood supply and mandatory avoidance of dead spaces. Atotal of 146operations were necessary (average 2.7operations/patient, range 1-7operations). In 24.1 % of the cases a one-stage approach could be carried out. In 41 patients negative pressure wound therapy (NPWT) with programmed sponge changing was used for wound conditioning (mean 5changes, standard deviation, SD± 5.6 changes over 22days, SD± 23.9days, change interval every 3-4days in 40.7% of the cases). In 33patients abilateral myocutaneous pectoralis major flap was used, in 4patients avertical rectus abdominis myocutaneous (VRAM) flap and in 7patients both were carried out. Atotal of 43osteosynthesis procedures were carried out on the sternum with fixed-angle titanium plates. Of the patients 7died during intensive care unit treatment (total mortality 13 %, n = 5, 9.3 % ≤ 30days) or in the later course. Of the patients 47 (87.1 %) could be discharged with acleansed infection. In 2patients the implant was removed after 2years due to loosening.

Redefining global cardiac surgery through an intersectionality lens

Although cardiovascular diseases are the leading cause of morbidity and mortality worldwide, six billion people lack access to safe, timely and affordable cardiac surgical care when needed. The burden of...

Abstract B042: Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart?

Abstract Introduction: Congenital coronary artery anomalies can increase the risk of sudden cardiac death, especially during exercise. Cancer patients with concurrent coronary artery disease face higher mortality rates due to delayed percutaneous coronary intervention. Furthermore, anthracycline chemotherapy, a common cancer treatment, can worsen pre-existing cardiac abnormalities. Despite the complexity of managing cancer patients with coronary artery anomalies, there is a lack of clear guidelines. This report presents a case of malignant interarterial course of the right coronary artery in a patient with Human T-lymphotropic virus type I-associated adult T-cell leukemia/lymphoma and discusses the challenges of chemotherapy in such cases. Case presentation: A 38-year-old male presented with weakness and palpitations. Laboratory findings revealed abnormalities, including elevated troponin and severe narrowing of the right coronary artery. Electrocardiograms showed ST elevations initially, followed by T-wave inversions. Although the patient had a pre-existing coronary anomaly, chemotherapy was initiated due to life-threatening tumor lysis syndrome and refractory lactic acidosis. Cardiac catheterization or surgical intervention was not possible due to comorbidities. A follow-up echocardiogram after six months of chemotherapy showed no acute changes. Discussion: Managing cancer patients with congenital coronary artery anomalies is challenging. Malignant interarterial course of the right coronary artery is particularly concerning due to the risk of sudden cardiac death. In this case, the patient's symptoms and abnormal electrocardiogram led to the identification of the coronary anomaly. However, immediate intervention was not feasible due to the patient's critical condition. The initiation of anthracycline-based chemotherapy in this patient posed a dilemma. Anthracyclines can cause cardiotoxicity, worsening pre-existing cardiac anomalies. Despite the lack of guidelines, chemotherapy was administered due to the urgent need for cancer treatment. Regular monitoring was essential to detect any cardiac changes. Conclusion: Managing cancer patients with coronary artery anomalies and administering anthracycline chemotherapy remains challenging due to limited guidelines. The case highlights the importance of recognizing and managing these anomalies to reduce the risk of sudden cardiac death. Guidelines for managing cardiac complications in cancer patients with pre-existing anomalies are needed. Further research is necessary to provide evidence-based guidance for such cases. Citation Format: Aliya M. Khan. Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B042.

Applications of EMbedding and backscattered scanning electron microscopy for morphological and functional assessment of the thymus forcedly removed in children with congenital heart defects during the first weeks of life

Thymectomy in a number of clinical situations is an unavoidable step of cardiac surgical treatment of congenital heart defects, but the issue of its effects on development of immunity in early ontogenesis remains open. There is still debates among scientists about the risk of immune deficiency states in children who underwent thymectomy at an early age. One may see completely different opinions, both in domestic and foreign publications. A tool for resolving this issue may be provided by morpho-functional studies of the removed thymic tissue by means of modern scanning electron microscopy techniques. The objective of our study was to assess the possibilities of EMbedding and backscattered scanning electron microscopy for morphological and functional evaluation of the thymus, which was forcedly removed in the infant patients with congenital heart defects over the first weeks of life. The thymus of a newborn infant (postnatal day 27) with congenital heart disease: ventricular septal defect was examined using EMbedding and backscattered scanning electron microscopy imaging after embedding in epoxy resin. The mass of thymus gland was 15.7 g, the dimensions of thymus were: transverse, 3.4 cm; longitudinal, 4.1 cm; thickness, 1.7 cm; volume, 12.4 cm3. The study showed ability of EMbedding and backscattered scanning electron microscopy in morphological and functional assessment of thymus gland considered the central organ of the immune system. Step-bystep visualization from low to high magnifications, from tissues to cells and intracellular structures, as well as layer-by-layer examination of thymic cortex, medulla, interlobular septa and vessels, allows you to effectively assess the functionality of the thymus. This research method is sufficient for scientific research of the forcedly removed thymus since it enables us to visualize its microanatomy, allowing cell phenotyping at different layers of the thymus, studying intercellular interactions of thymocytes with reticulo-epithelial cells, subtle features of Hassall’s bodies and, finally, the process of T lymphocytes’ release from thymus gland.

Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration.

The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration. To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection. This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period. The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively). Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.

Abstract 18890: Outcomes for Patients With STEMI vs NTEMI in COVID-19: A Contemporary National Insight

Introduction: The COVID-19 pandemic posed significant challenges to cardiovascular care. Previous studies have shown that patients with NSTEMI type II have worse outcomes than those with NSTEMI type I or STEMI. In 2020, STEMI incidence was disproportionately high compared to NSTEMI. Since there are no ICD 10 codes to differentiate NSTEMI types I and II, we sought to compare patients with COVID-19 admitted for STEMI vs NSTEMI using the NIS database. Hypothesis: Given the initial pandemic response, we expect outcomes for STEMI to be worse than NSTEMI in COVID-19 patients. Methods: A retrospective analysis was completed utilizing the National Inpatient Sample (2020). Patients were identified based on ICD-10 codes corresponding to those with COVID-19 and STEMI vs. patients with COVID-19 and NSTEMI. Primary outcomes were mortality, length of stay (LOS) and total hospital charge (TOTHC). Secondary outcomes were analyzed using multivariate analysis. Results: 1,685,745 patients had COVID-19, of which 39,246 had a STEMI, and 5,818 had a NSTEMI. Average age was 62.. When comparing COVID-19, patients with STEMI vs. NSTEMI, the mortality odds ratio (OR) was 2.5 (95% CI 2.28-3.75, p &lt; 0.001) and LOS was -1.27 days. Primary and secondary outcomes are described in Table 1. Conclusions: STEMI was significantly associated with increased mortality in the setting of COVID-19. This may explain the lower LOS and lack of difference in TOTHC between the two groups. This may be related to the initial pandemic response of strict isolation protocols with closing of catheterization and surgical suites. Patients with STEMI and COVID-19 most likely were medically managed or diagnosed late leading to increased mortality. Intubation, cardiogenic shock and cardiac arrest were all significantly associated with increased mortality, LOS and TOTHC. Future studies may show reversal of these outcomes given a return to standard operations with respect to cardiac catheterization and surgical intervention.

Use of an intra-aortic balloon pump to improve cerebral oxygen saturation after resuscitation in a cardiac surgical intervention

Use of an intra-aortic balloon pump to improve cerebral oxygen saturation after resuscitation in a cardiac surgical intervention

Optimising motor development in the hospitalised infant with CHD: factors contributing to early motor challenges and recommendations for assessment and intervention.

Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists' role in caring for infants with critical CHD in intensive or acute care hospital units. This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed. Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant's overall development.