Heart Surgery Research Articles

Four-dimensional endocardial surface imaging with dynamic virtual reality rendering: a technical note.

Open heart surgery requires a proper understanding of the endocardial surface of the heart and vascular structures. While modern four-dimensional (4D) imaging enables excellent dynamic visualization of the blood pool, endocardial surface anatomy has not routinely been assessed. 4D image data were post-processed using commercially available virtual reality (VR) software. Using thresholding, the blood pool was segmented dynamically across the imaging volume. The segmented blood pool was further edited for correction of errors due to artifacts or inhomogeneous signal intensity. Then, a surface shell of an even thickness was added to the edited blood pool. When the cardiac valve leaflets and chordae were visualized, they were segmented separately using a different range of signal intensity for thresholding. Using an interactive cutting plane, the endocardial surface anatomy was reviewed from multiple perspectives by interactively applying a cutting plane, rotating and moving the model. In conclusions, dynamic three-dimensional (3D) endocardial surface imaging is feasible and provides realistic simulated views of the intraoperative scenes at open heart surgery. As VR is based on the use of all fingers of both hands, the efficiency and speed of postprocessing are markedly enhanced. Although it is limited, visualization of the cardiac valve leaflets and chordae is also possible.

Стентування відкритої протоки як перший етап хірургічного лікування тетради Фалло з незливними гілками легеневої артерії

The aim – to show the results of patent ductus arteriosus (PDA) stenting as the first stage of palliative treatment in patients with tetralogy of Fallot with non-confluent branches of the pulmonary artery.Materials and methods. This retrospective, single-center study included 10 consecutive patients who underwent PDA stenting since 2013 to 2023. The average age at the time of surgery was 96.00 ± 82.92 days (range 4 to 411 days), the average weight was 5.10 ± 1.78 kg (range 2.8 to 11 kg). The arterial oxygen saturation level (SaO2) before the intervention was 72.0 ± 6.7 % (range 60 to 87 %).Results. There were no intraoperative complications in all patients of this group. The length of the stay in the intensive care unit after surgery was 5.00 ± 1.36 days. SaO2 level increased to 89.00 ± 4.08 %. The duration of artificial lung ventilation after surgery was 36.5 ± 18.00 hours, and the duration of inotropic support was 81.1 ± 33.8 hours. In the long term, all patients showed significant growth of the native pulmonary artery branches. All patients of this group achieved total repair of this pathology after 192.00 ± 60.28 days, on average. At the moment of total repair, the size of the left branch of the pulmonary artery increased from 3.9 ± 0.8 mm to 7.8 ± 1.6 mm, and the right branch increased from 5.8 ± 1.2 mm to 7.70 ± 1.04 mm; the Nakata index increased from 133.0 ± 29.1 mm2/m2 to 241.2 ± 97.8 mm2/m2; end-diastolic index of the left ventricle increased from 31.4 ± 10.8 ml/m2 to 43.1 ± 11.4 ml/m2.Conclusion. PDA stenting in patients with tetralogy of Fallot combined with non-confluent branches of the pulmonary artery is an effective palliative procedure. This method allows to postpone the total repair to an older age, ensures sufficient and symmetric growth of the branches of pulmonary artery, and helps to avoid risks associated with repeat open heart surgeries.

Discussions in Cardiothoracic Treatment and Care: Organization of centers performing congenital heart surgery

Discussions in Cardiothoracic Treatment and Care: Organization of centers performing congenital heart surgery

Cantharidin and sodium fluoride attenuate the negative inotropic effect of the A1-adenosine receptor agonist N6-(R)-phenylisopropyl adenosine in isolated human atria.

Cantharidin and sodium fluoride inhibit the activity of serine/threonine protein phosphatases 1 (PP1) and 2A (PP2A) and increase the force of contraction in human atrial preparations. R-phenylisopropyl adenosine (R-PIA) acts as an agonist at A1-adenosine receptors. R-PIA exerts a negative inotropic effect on human atria. The effect of R-PIA-and its various manifestations-are currently explained as a function of the inhibition of sarcolemmal adenylyl cyclase activity and/or opening of sarcolemmal potassium channels. We hypothesise that cantharidin and sodium fluoride may attenuate the negative inotropic effect of R-PIA. During open heart surgery, trabeculae carneae from the right atrium were obtained for human atrial preparations (HAPs). These trabeculae were mounted in organ baths and electrically stimulated at 1Hz. Furthermore, we studied isolated electrically stimulated left atrial (LA) preparations from female wild-type mice (CD1). The force of contraction was recorded under isometric conditions. R-PIA (1µM) exerted a rapid negative inotropic effect in the HAPs and mice LA preparations. These negative inotropic effects of R-PIA were attenuated by pre-incubation for 30min with 100-µM cantharidin in HAPs, but not in mice LA preparations. Adenosine signals via A1 receptors in a species-specific pathway in mammalian atria. We postulate that R-PIA, at least in part, exerts a negative inotropic effect via activation of serine/threonine phosphatases in the human atrium.

Immediate effects of upper limb exercises with and without deep breathing on lung function after cardiac surgery – a randomized crossover trial

BackgroundOpen heart surgery, involving median sternotomy, may cause diminished chest wall motion and restrictive pulmonary function in the early postoperative period. Thoracic and upper extremity range of motion (ROM) exercises are often recommended after surgery but have not been evaluated regarding effect on lung volumes and oxygenation. The objective of this study was to evaluate the immediate effect of upper limb elevations, with or without simultaneous deep breathing, on lung function after cardiac surgery.MethodsIn a randomized 2 × 2 crossover trial, 22 adult patients (> 18 years old) were assessed during one of the first days after surgery in the spring of 2022 at Örebro University Hospital, Sweden. Exercises involving five bilateral upper limb elevations, performed either with simultaneous deep breathing (ROM-DB) or without (ROM), while sitting in an upright position at the edge of the bed, were evaluated. Peripheral oxygen saturation (Rad-5v; Masimo, Irvine, USA) was the primary outcome. Tidal volume and respiratory rate were recorded continuously during the exercises (Spiropalm; Cosmed, Rome, Italy). Heart rate, pain, exertion and dyspnoea were evaluated before and after the exercises.ResultsBoth ROM-DB and ROM momentarily increased peripheral oxygen saturation (+ 1% ± 1, p = 0.004 and + 1% ± 1, p < 0.001, respectively), with no significant differences between these exercises (p = 0.525). ROM-DB significantly increased the VT compared with ROM (798 ± 316 vs. 602 mL ± 176, p = 0.004). However, ROM-DB induced more pronounced pain (p = 0.012), exertion (p = 0.035) and dyspnoea (p = 0.013) than ROM.ConclusionsUpper limb elevations improved oxygenation momentarily, both performed with and without simultaneous deep breathing, with no significant differences between these exercises. The additive deep breathing improved tidal volume compared with upper limb elevations alone, but induced more pain, exertion and dyspnoea during the performance of exercise.Trial registrationClinicalTrials.gov (NCT05278819).

Outcomes Following Neonatal Cardiac Surgery in Cape Town, South Africa.

Neonatal Cardiac Surgery has developed significantly since its advent, with improved outcomes, survival, and physiological repair. Limited programs offer neonatal cardiac surgery in emerging economies. We report our experience with neonates undergoing cardiac surgery in our cardiac surgery program. We performed a secondary data analysis on all neonates aged ≤ 30 days undergoing congenital cardiac surgery from April 1, 2017 to March 31, 2020, including outcomes up to 30-days post-surgery. A total of 859 patients underwent cardiac surgery at our center, of these 81 (9.4%) were neonates. The proportion of neonates increased annually (8.7%, 9.6%, and 10.2%). There were 49 (60%) male patients, and 32 (40%) had surgery in the second week of life. Fourteen (17%) were premature, four (5%) had a major chromosomal abnormality, five (6%) a major medical illness, and eight (10%) a major noncardiac structural anomaly. The Risk Adjustment for Congenital Heart Surgery (RACHS) categorization of surgery was predominantly RACHS 3; n = 28 (35%) and 4; n = 23 (29%). Hours in the intensive care unit (ICU) were extensive; median 189 [interquartile range (IQR): 114-286] as were hours of ventilation; median 95 [IQR 45-163]. Almost 60% (n = 48) of procedures were complicated by sepsis, as defined in our database. The in-hospital mortality rate was 16% (n = 13); the 30-day mortality rate was 19.8% (n = 16). The proportion of neonates in our service increased over the period. Focused strategies to shorten prolonged ICU stay and decrease rates of bacterial sepsis in neonates are needed. A multidisciplinary, collaborative heart-team approach is crucial for best outcomes.

Postoperative Organ Dysfunction Risk Stratification Using Extracellular Vesicle-Derived circRNAs in Pediatric Congenital Heart Surgery.

Breakthroughs in surgical and medical techniques have significantly improved outcomes for children with congenital heart disease (CHD), but research continues to address the ongoing challenge of organ dysfunction after surgery, particularly in neonates and infants. Our study explored circular RNAs (circRNAs) within plasma-derived extracellular vesicles (EVs) in neonates and infants undergoing CHD surgery. Post-surgery EV circRNAs showed dramatic expression changes between organ dysfunction (OD) and control groups. Tissue injury-related pathways were consistent across pre- and post-surgery in OD. The top two significant predicted tissue sources of these circRNAs originated from the respiratory system, aligning with the fact that all patients in the OD arm experienced respiratory dysfunction. Five of these circRNAs, namely circ-CELSR1, circ-PLXNA1, circ-OBSL1, circ-DAB2IP, and circ-KANK1, significantly correlated with PELOD (Pediatric Logistic Organ Dysfunction) score and demonstrated high performance (AUC = 0.95), supporting the potential of circRNAs as prognostic markers. These findings pave the way for EV circRNAs as promising tools for managing post-surgical organ dysfunction and potentially guiding therapeutic strategies in children with CHD.

The Comparison between the conservative approach and pectoralis major flap transposition in the treatment of mediastinitis following median sternotomy

Background: Mediastinitis is a significant complication of open heart surgery and other thoracic operations. Deep sternal wound complications notably increase morbidity and mortality. The optimal treatment for deep sternal wounds following sternotomy remains a topic of discussion. Options such as repeated irrigation and debridement of the wound, closed chest catheter irrigation, and recent plastic surgery approaches like pectoralis major flap transposition all have their proponents Methods: Given the high prevalence of Deep Sternal Wound Infection (DSWI), we conducted this retrospective descriptive study. We used existing information to compare the conservative method of repeated irrigation and debridement with pectoralis major flap transposition. We presented the results using descriptive and analytic methods. We evaluated a total of 125 patient health records with deep sternal wound infection over a ten-year period (2003-2013). Results: The results of this study showed that 83.2% of patients who developed DSWI after surgery suffered from underlying diseases such as diabetes, renal failure, etc. However, no relationship was found between the presence of an underlying disease and recovery. Furthermore, no significant relationship was observed between diabetes and recovery. Among the 125 assessed files, 50 patients received a pectoralis flap, among which 48 patients recovered with sternal stabilization and only 2 patients recovered without stabilization. Conversely, among cases without pectoralis flapping, records were available for only 67 patients, of whom only 35 patients recovered with sternal stabilization while 32 patients recovered without sternal stabilization. Recovery was significantly enhanced in the group receiving flapping. Conclusions: The only factor that improved the outcome in our assessment was the use of pectoralis flapping. This is consistent with the results of studies published in recent years that used plastic surgery methods, i.e., pectorals muscle or omentum flapping, which are associated with a high success rate and reduced length of inpatient stay.

Safety and Effectiveness of Acceleration Training as Cardiac Rehabilitation Immediately After Open Heart Surgery - A Pilot Study.

We examined the safety and efficacy of acceleration training (AT) in patients immediately after cardiac surgery. This randomized controlled study included patients who underwent open-heart surgery using cardiopulmonary bypass. Of these patients, 31 received regular cardiac rehabilitation (CR) and 39 received AT in addition to regular CR (AT group). AT was provided using a vibration platform (Power Plate®Pro7TMand Power plate®personal; Performance Health System, Chicago, IL, USA). The AT group performed 5 static resistance training sessions: squats, wide stance squats, toe stands, banded squats, and front lunges. Each vibration session lasted 30 s. We evaluated the short physical performance battery, anterior mid-thigh thickness, maximum voluntary isometric contraction of the knee extensors, and serum intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) concentrations as indicators of endothelial function. The observation period was during hospitalization and lasted approximately 20 days. No adverse events occurred during AT. Ultrasound revealed a significantly lower reduction in muscle mass at discharge in the AT group. No significant differences were observed in ICAM-1 and VCAM-1 concentrations between the 2 groups preoperatively, postoperatively, or at discharge. AT is considered safe and effective for patients immediately after open-heart surgery. AT, along with regular CR, may prevent skeletal muscle mass loss, muscle weakness, and physical function loss immediately after open-heart surgery.

Establishment of cerebral perfusion in a rat model with extracorporeal life support.

Background: Extracorporeal life support echniques as an Adjunct to Advanced Cardiac Life Support is usually suitable for complex heart surgery such as cardiopulmonary bypass (CPB). Cerebral perfusion is a clinically feasible neuroprotective strategy; however, the lack of a reliable small animal model.Methods: Based on the rat model of ECLS we evaluate the effects of ECLS-CP using HE staining, Nissl staining, TUNEL staining and ELISA.Result: We found that ECLS combined with the cerebral perfusion model did not cause brain injury and immune inflammation. There was no difference between the two by a left carotid artery or right carotid artery CP.Conclusion: These experimental results can provide the experimental basis for selecting blood vessels for ECLS patients and clinical CP to offers a trustworthy animal model for future exploration of applying brain perfusion strategies during ECLS-CP.

Intravascular Lithotripsy: Approach to Advanced Calcified Coronary Artery Lesions, Current Understanding, and What Could Possibly Be Studied Next.

Calcified and resistant narrowing of arteries poses significant difficulty in performing percutaneous coronary interventions (PCIs), as they increase the risk of subpar outcomes leading to worse clinical outcomes. Despite the existence of dedicated technologies and devices, including various balloons and atherectomy systems, they often do not ensure sufficient plaque modification and ideal vessel preparation for optimal stent deployment. Intravascular lithotripsy (IVL), a technology originally developed for urological procedures, has recently been used to safely and selectively disrupt calcified depositions in both peripheral and coronary arteries by sonic waves that seamlessly transfer to nearby tissue, enhancing vessel compliance with minimal impact on soft tissues. In the coronary arteries, the use of IVL plays a role in the process of "vessel preparation" before the placement of stents, which is crucial for restoring blood flow in patients with severe coronary artery disease (CAD), and is considered a minimally invasive technique, reducing the need for open heart surgeries and associated risks and complications. Studies have shown that IVL can lead to improved procedural success rates and favorable long-term outcomes for patients with severely calcified coronary artery disease. With the advent of IVL, the disruption of severe calcification of coronary artery and stenotic lesions before stent implantations can be performed. Despite promising data for treating calcified lesions, IVL is significantly underutilized in clinical practice, long-term clinical data and extensive research are needed to validate its further safety and efficacy. In this article, we reviewed the literature discussing the use of IVL in the coronary arteries as an approach for addressing intravascular atherosclerotic plaques, particularly focusing on heavily calcified plaques that are resistant to standard initial PCI, while also evaluating its safety in comparison to alternative methods.

The concept DOCTOR in the language consciousness of adolescents with CHD after heart surgery and their conventionally healthy peers

The concept DOCTOR in the language consciousness of adolescents with CHD after heart surgery and their conventionally healthy peers

Correlation of the concepts DISEASE and CONGENITAL HEART DEFECT (CHD) in language consciousness of teenagers after heart surgery

Correlation of the concepts DISEASE and CONGENITAL HEART DEFECT (CHD) in language consciousness of teenagers after heart surgery

Cardiac surgery associated acute kidney injury, incidence, and predictors. Prospective observational single center study.

Acute kidney injury (AKI) is a condition characterized by a sudden decline in kidney function, leading to accumulation of waste products and fluids in the body. It is a common and serious complication in patients with cardiovascular diseases, and it is associated with increased morbidity and mortality.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Aim&lt;/b&gt;&lt;br /&gt; In this study, we explore the relationship between cardiac issues and the development of AKI, as well as strategies for its prevention and management. The primary aim of this study is to examine the incidence and risk factors for the AKI in patients admitted to the cardiac intensive care unit/CICU), as well as the impact of AKI on patient outcomes.&lt;br /&gt; &lt;b&gt;&amp;nbsp;&lt;/b&gt;&lt;br /&gt; &lt;b&gt;Methods&lt;/b&gt;&lt;br /&gt; We conducted prospective observational single center study. 292 consecutive patients admitted to ICU after open heart surgery by sternotomy were included. Patients were monitored in ICU for frequency of AKI, perioperative risk factors, cardiac surgery-associated acute kidney injury (CSA-AKI) and their impact on patients’ outcome.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; After admission to the intensive care unit, 33 patients (11.3%) developed CSA-AKI in the postoperative period. According to the analysis, male gender (p=0.03), decreased GFR (p=0.02) as well as high EuroSCORE II (p=0.013), hemoglobin level before surgery (p = 0.002) and the presence of diabetes and chronic kidney disease (p=0.03) were independent predictors of AKI after open-heart surgery. In patients who developed AKI, the duration of artificial lung ventilation was increased (21.3 vs 9.9 hours p = 0.001) and the duration of stay in the intensive care unit (4.3 vs. 1.9 days, P = 0.02).&lt;br /&gt; &lt;b&gt;&amp;nbsp;Conclusion:&lt;/b&gt;&lt;br /&gt; Patients often have AKI after heart surgery. EuroSCORE II, gender, diabetes, time of cardiopulmonary bypass and chronic kidney disease are independent predictors of AKI development. The appearance of AKI is due to an unfavorable outcome of events. The appearance of acute kidney injury is associated with adverse consequences.&lt;br /&gt; &lt;b&gt;&amp;nbsp;Key words: &lt;/b&gt;Acute kidney injury, cardiac surgery, predictors of AKI, postoperative period.&lt;br /&gt; &lt;br /&gt; &amp;nbsp;&lt;b&gt;Conflict of interests: &lt;/b&gt;The authors declare no conflict of interest.

An Automated Engineering Model to Forecast Cardiac Arrests' Need for Heart Surgery

An Automated Engineering Model to Forecast Cardiac Arrests' Need for Heart Surgery

Comparison of Continuous Thoracic Epidural Analgesia Versus Bilateral Erector Spinae Plane Block for Pain Management in Coronary Bypass Surgery.

Background Effective pain control is vital for patients undergoing heart surgery. Utilizing a multimodal approach to analgesia is essential, as poor pain management can result in hemodynamic and systemic complications. This study aimed to compare perioperative pain management techniques in patients undergoing coronary artery bypass grafting (CABG), specifically evaluating continuous thoracic epidural analgesia and ultrasound-guided bilateral erector spinae block. Methods This randomized comparative study was conducted at a tertiary care centreover a period of six months, with approval from the institute's ethics committee. A total of 24 patients undergoing CABG under general anesthesia participated in the study. They were randomly assigned to either the continuous thoracic epidural analgesia (TEA) group (Group A) or the ultrasound-guided bilateral erector spinae plane (ESP) block group (Group B) using a simple randomization method. The study assessed intraoperative intravenous opioid requirements for maintaining stable hemodynamics, as well as postoperative resting and coughing Visual Analog Scale (VAS) scores and peak inspiratory spirometry. Results Twelve patients from each group completed the study, with comparable demographics (age, gender). Both groups exhibited similar resting and coughing VAS scores at 0, 3, 6, and 12 hours postoperatively (p > 0.05). However, at 24, 36, and 48 hours, Group A had significantly higher VAS scores compared to Group B (p < 0.05). Group A maintained an overall mean VAS score of 4 or less during rest and coughing. Peak inspiratory spirometry results were consistent between both groups (p > 0.05). Conclusion The ultrasound-guided bilateral erector spinae block provided pain control comparable to thoracic epidural analgesia, making it a viable alternative for perioperative pain management. This is particularly beneficial for CABG patients where early postoperative anticoagulant therapy is crucial for graft patency. Effective pain management also contributes to faster recovery in coronary artery bypass grafting.

Correlation between Functionality and Quality of Life in Patients after Cardiac Surgery

&lt;b&gt;Abstract&lt;/b&gt;&lt;br /&gt; This study aims to investigate the relationship between early physical exercise and patients' functional ability and quality of life after cardiac surgery. A total of 100 patients, ages 18 to 65, 52 men and 48 women, took part in the early physical activity program following cardiac surgery from the first to the seventh postoperative day. The six-minute walk test (6MWT), short form-international physical activity questionnaire (SF-IPAQ), and short form-36 (SF-36) quality of life were used as outcome measures. Each test and questionnaire completed on the seventh day following cardiac surgery. According to statistical analysis, there was a statistically significant correlation (P&amp;lt;0.001) between the SF-IPAQ score and the 6MWT and SF-36. According to our findings, patients who had heart surgery reported higher levels of physical activity and better quality of life as well as increased functional ability.

Some Useful and Unusual Eponymous Cardiac Surgical Techniques Adopted in Chittagong Medical College Hospital

Background: Innovation is an integral part of cardiac surgery. A number of natural barriers had to be overcome by the cardiac surgery pioneers to establish open heart surgeries in the 1950s. Since then, surgeons are continuously developing and adopting various innovative techniques to ensure safety and efficacy of cardiac surgery. The Department of Cardiac Surgery of Chittagong Medical College Hospital (CMCH) has some unique characteristics as it was developed isolated from the centers of Dhaka. A few interesting methods are in practice here, which worth mentioning for the outside readers. Some of these procedures have been colloquially named in our department often after the visiting surgeon or the team who introduced those here. Methods: The unique and unusual techniques applied in CMCH were sought and discussed. The hospital records, OT operation notes and ICU log books were thoroughly searched for any clue. The local and visiting team members were interviewed for any information. All available data were compiled and analyzed. Results: Six interesting and useful named surgical techniques adopted in CMCH Cardiac Surgery Department were identified. These are: 1. Marine city ASD Closure Technique, 2. Tendolkar’s Maneuver during CPB, 3. Turkish Sling in CABG, 4. Petlar Stitch in VSD closure, 5. Pyongyang Method of LA Closure and 6. NAK-NAKA De-calcification Procedure for valve surgery. The first two were introduced with the help of visiting Indian Professor Anil Tendolkar, whereas the 3rd was introduced by a visiting Turkish team. The 4th technique was adopted from a pediatric cardiac surgeon from Dhaka. The 5th and 6th techniques have long been in practice at NICVD, which were adopted with some modification in our department. Conclusion: The above mentioned six reproducible techniques are unique and useful. Sharing and discussion of these techniques will enable other Bangladeshi surgeons to adopt these useful tips. Cardiovasc j 2024; 16(2): 86-91

Intraoperative zero-heat-flux thermometry overestimates nasopharyngeal temperature by 0.39°C: an observational study in patients undergoing congenital heart surgery.

During surgery for congenital heart disease (CHD) temperature management is crucial. Vesical (Tves) and nasopharyngeal (TNPH) temperature are usually measured. Whereas Tves slowly responds to temperature changes, TNPH carries the risk of bleeding. The zero-heat-flux (ZHF) temperature monitoring systems SpotOn™ (TSpotOn), and Tcore™ (Tcore) measure temperature non-invasively. We evaluated accuracy and precision of the non-invasive devices, and of Tves compared to TNPH for estimating temperature. In this prospective observational study in pediatric and adult patients accuracy and precision of TSpotOn, Tcore, and Tves were analyzed using the Bland-Altman method. Proportion of differences (PoD) and Lin´s concordance correlation coefficient (LCC) were calculated. Data of 47 patients resulted in sets of matched measurements: 1073 for TSpotOn vs. TNPH, 874 for Tcore vs. TNPH, and 1102 for Tves vs. TNPH. Accuracy was - 0.39°C for TSpotOn, -0.09°C for Tcore, and 0.07°C for Tves. Precisison was between - 1.12 and 0.35°C for TSpotOn, -0.88 to 0.71°C for Tcore, and - 1.90 to 2.05°C for Tves. PoD ≤ 0.5°C were 71% for TSpotOn, 71% for Tcore, and 60% for Tves. LCC was 0.9455 for TSpotOn, 0.9510 for Tcore, and 0.9322 for Tves. Temperatures below 25.2°C (TSpotOn) or 27.1 (Tcore) could not be recorded non-invasively, but only with Tves. Trial registration German Clinical Trials Register, DRKS00010720.

Establishment of a Global Platform for the Treatment of Congenital Heart Disease by "Creation and Unification of National Congenital Heart Surgery Databases and Registries": It's Time!

Establishment of a Global Platform for the Treatment of Congenital Heart Disease by "Creation and Unification of National Congenital Heart Surgery Databases and Registries": It's Time!