Surgery For Congenital Heart Defects Research Articles

Using Machine Learning and Feature Importance to Identify Risk Factors for Mortality in Pediatric Heart Surgery.

Background: The objective of this IRB-approved retrospective monocentric study was to identify risk factors for mortality after surgery for congenital heart defects (CHDs) in pediatric patients using machine learning (ML). CHD belongs to the most common congenital malformations, and remains the leading mortality cause from birth defects. Methods: The most recent available hospital encounter for each patient with an age <18 years hospitalized for CHD-related cardiac surgery between the years 2011 and 2020 was included in this study. The cohort consisted of 1302 eligible patients (mean age [SD]: 402.92 [±562.31] days), who were categorized into four disease groups. A random survival forest (RSF) and the 'eXtreme Gradient Boosting' algorithm (XGB) were applied to model mortality (incidence: 5.6% [n = 73 events]). All models were then applied to predict the outcome in an independent holdout test dataset (40% of the cohort). Results: RSF and XGB achieved average C-indices of 0.85 (±0.01) and 0.79 (±0.03), respectively. Feature importance was assessed with 'SHapley Additive exPlanations' (SHAP) and 'Time-dependent explanations of machine learning survival models' (SurvSHAP(t)), both of which revealed high importance of the maximum values of serum creatinine observed within 72 h post-surgery for both ML methods. Conclusions: ML methods, along with model explainability tools, can reveal interesting insights into mortality risk after surgery for CHD. The proposed analytical workflow can serve as a blueprint for translating the analysis into a federated setting that builds upon the infrastructure of the German Medical Informatics Initiative.

Observation of patients after cardiac surgery, surgical aspects for pediatricians

The article discusses the practical aspects of caring for children after heart surgery. It provides information on the timing of follow-ups, the frequency of pediatrician visits, and describes the most important aspects of patient management for different groups. The article identifies several groups of patients based on their postoperative risks and follow-up needs. Purpose of the article is to present the observation features of patients who have undergone surgery for congenital heart defects, from the perspectives of surgeons and pediatricians.

Impact of Intraoperative Blood Transfusion on Cerebral Injury in Pediatric Patients Undergoing Congenital Septal Heart Defect Surgery

Background: The components of donor blood themselves have the potential to initiate a systemic inflammatory response and exacerbate neuroinflammation, resulting in subsequent cerebral injury. The aim of this study was to establish the role of transfusion in the development of cerebral injury during the correction of congenital heart defects in children. Material and Methods: A total of 78 patients aged from 1 to 78 months, with body weights ranging from 3.3 to 21.5 kg, were investigated. Biomarkers of cerebral injury and systemic inflammatory response were studied at three time points. First: prior to the surgical intervention. Second: after the completion of cardiopulmonary bypass. Third: 16 h after the conclusion of the surgery. Results: The strongest correlation was found for S-100-β protein with the volume of transfusion at the second (Rho = 0.48, p = 0.00065) and third time points (Rho = 0.36, p = 0.01330). Neuron-specific enolase demonstrated a similar trend: Rho = 0.41 and p = 0.00421 after the completion of cardiopulmonary bypass. Conclusions: The use of red blood cell suspension and its dosage per kilogram of body weight correlated with the biomarkers of cerebral injury and systemic inflammatory response with moderate to significant strength.

Ultrasound-Based Cardiac Output Monitoring During Pediatric Open-Heart Surgery in Children

Aim of the study. To evaluate the feasibility of using non-invasive hemodynamic monitoring technology based on Doppler ultrasound during open-heart surgery in children.Material and methods. Prospective, observational, single-center cohort study included 20 patients aged 10 to 34 months undergoing surgery for congenital heart defects. Ten patients underwent atrial septal defect closure (ASD group), other 10 patients had ventricular septal defect closure (VSD group). Cardiac output (CO) was measured in all patients to guide inotropic and infusion therapy adjustments at three control time points: (1) after intubation and before skin incision, (2) during the immediate post-bypass period with the chest open after weaning from cardiopulmonary bypass (CPB), and (3) after sternal closure and before transfer to the intensive care unit (ICU).Results. At time point 1, the CO values for both the ASD and VSD groups were within the normal reference range: 5.2 L/min [4.7; 5.5] and 5.1 L/min [4.6; 5.6], respectively. At time point 2, CO was measured in 15 of 20 patients, including 8 patients in the ASD group and 7 in the VSD group. Coverage was 75% because of the challenges of measuring 5 patients on the operating table. In the immediate post-bypass period, two patients with VSD (25%) developed hypotension with CO reduced to 3.6 L/min, which is lower than the age-related hemodynamic reference value (5.1 L/min). Inotropic support in these two patients was increased by switching from dopamine, 7 mcg/kg/min, to adrenaline at a dose of 0.05 mcg/kg/min, resulting in improvement of hemodynamic parameters and an increase in CO to 5.2 L/min and 5.0 L/min, respectively, compared to normal agerelated reference values (4.1; 6.1 L/min). After sternal closure, CO values in both groups did not differ significantly from age-related reference values.Conclusion. The USCOM cardiac output monitoring device can be used to manage intraoperative hemodynamics and adjust inotropic therapy even during open chest surgery. However, its routine use in all stages of surgery with median sternotomy is difficult because it requires more time to align the aortic valve projection.

Second‐Trimester Ultrasound Receipt Mediates the Relationship Between Public Insurance and Prenatal Diagnosis of a Congenital Heart Defect

ABSTRACTObjectiveTo delineate the mechanism behind insurance‐related disparities in the prenatal diagnosis of a congenital heart defect (CHD).MethodsThis was a retrospective analysis of electronic health records of pregnant individuals whose infants received CHD surgery between 2019 and 2020 in the third‐largest United States metropolitan area. The outcome was whether a prenatal diagnosis was received. The exposure was the pregnant individual's insurance status. The mediator was second‐trimester ultrasound receipt. Control variables included sociodemographic and clinical characteristics of the pregnant individual and infant. The relationships between exposure, mediator, and outcome were quantified using mediation analysis with multivariable fixed‐effects regression.ResultsIn total, 496 pregnant individuals met inclusion criteria; 215 (43.3%) were publicly insured and 305 (61.5%) had prenatal diagnosis. In bivariate regressions, public insurance was associated with a 12.6% lower probability (CI 3%–21%) of prenatal diagnosis. In multivariable models, public insurance was associated with 13.2% lower probability (CI 2%–25%) of second‐trimester ultrasound receipt but was no longer associated with prenatal diagnosis after adjusting for second‐trimester ultrasound receipt, suggesting a possible mediation effect. Mediation analysis confirmed that second‐trimester ultrasound receipt mediated 39% of the relationship between public insurance and prenatal diagnosis.ConclusionAn appreciable portion of insurance‐related differences in prenatal CHD diagnosis is due to the lower frequency of second‐trimester ultrasound receipt among those with public insurance.

Pre- and postoperative levels of serum brain-derived neurotrophic factor in neonates with congenital heart defects.

The objectives of this study were to assess the preoperative and postoperative serum brain- derived neurotrophic factor (BDNF) levels in neonates undergoing surgery for congenital heart defects (CHD). Also to explore the relationship between changes in BDNF levels and the impact of perioperative factors including intraoperative body temperature, aortic cross-clamp time, perfusion time, operation time, inotropic score, vasoactive inotropic score and lactate levels. Forty-four patients with CHD and 36 healthy neonates were included in the study. Blood samples for serum BDNF levels were collected three times: preoperatively, and at 24 and 72 hours postoperatively from each patient in the operated group. Additionally, samples were collected once from each individual in the non-operated case group and the control group. Serum BDNF levels were analyzed using the Elabscience ELISA (Enzyme-Linked Immunosorbent Assay) commercial kit. Cranial ultrasonography (USG) was performed on all infants with CHD. Following cardiac surgery, patients underwent second and third cranial USG examinations at 24 and 72 hours postoperatively, respectively. Forty-four consecutive patients with CHD were divided into two groups as follows: the operated group (n=30) and the non-operated group (n=14). Although there were no differences in the baseline serum BDNF levels between the case and control groups, the preoperative serum BDNF levels were significantly lower in the patients operated compared to the non-operated patients. The serum BDNF levels at the 24th hour postoperatively were higher than the preoperative levels. However, no significant correlation was found between the serum BDNF levels at 24 and 72 hours postoperatively as well as the cranial USG findings at corresponding times. Serum BDNF levels were initially lower in neonates with CHD who underwent surgery, but increased during the early postoperative period. These results suggest that serum BDNF levels are influenced by CHD and the postoperative period.

AUDITORY AND VERBAL MEMORY DISORDER IN YOUNG SCHOOLCHILDREN WITH CONGENITAL HEART DEFECTS

Highlights The presented literature review points to new questions associated with cognitive impairment in patients with congenital heart defects. We propose that cognitive and behavioral impairments in patients with CHD are common, but their development trajectory and degree of severity depend on the CHD subtype. Aim. To study the features of auditory and verbal memory in young schoolchildren who underwent cardiac surgery.Methods. The study included 104 children from 7 to 10 years old, who underwent on-pump cardiac surgery for congenital heart defects at the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2019 to 2022. We analyzed anamnesis data, clinical and hemodynamic picture, the risk of mortality from surgery according to the RACHS scale, and assessed the auditory and verbal memory according using methodical manual by T.A. Fotekova and T.V. Akhutina (block 1 series 3, block 2 series 1) during 1-year follow up.Results. All children had presented with stage I chronic heart failure (functional class II) at the time of hospitalization. The outcome of surgery was mostly positive a year after the surgery: children had no heart failure symptoms or hemodynamic disorders, however, 80% of children had auditory and verbal memory impairments.Conclusion. In addition to standard methods of examining children with congenital heart disease, it is necessary to introduce a comprehensive interdisciplinary approach that would include the assessment of neurocognitive status before and after surgery.

Pneumonia, wheezing and asthma were more common in children after thymectomy due to open-heart surgery.

This nationwide study evaluated the clinical impact that an early thymectomy, during congenital heart defect (CHD) surgery, had on the health of children and adolescents. The subjects were patients aged 1-15 years who had undergone CHD surgery at the University Children's Hospital, Helsinki, where all CHD surgery in Finland is carried out, from 2006 to 2018. The parents or the cases and population-based controls, matched for sex, age and hospital district, completed electronic questionnaires. We excluded those with low birth weights or a known immunodeficiency. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for prespecified outcomes. We received responses relating to 260/450 (58%) cases and 1403/4500 (31%) controls and excluded 73 cases with persistent cardiac or respiratory complaints after surgery. The CHD group reported more recurrent hospitalisations due to infections (aOR 6.3, 95% CI 3.0-13) than the controls and more pneumonia episodes (aOR 3.5, 95% CI 2.1-5.6), asthma (aOR 2.5, 95% CI 1.5-4.1) and wheezing (aOR 2.1, 95% CI 1.5-2.9). Hospitalisation due to infections, pneumonia, wheezing and asthma was more common in children after a thymectomy due to open-heart surgery than population-based controls, underlining the importance of immunological follow-ups.

Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients.

Arrhythmia is one of the most common complications after cardiac surgery. The objectives of this study were to determine the prevalence and analyze the risk factors of postoperative arrhythmia in pediatric patients after cardiac surgery for congenital heart defects (CHD) at a single center in Bali, Indonesia over 2 years period. A cross-sectional study, among 120 pediatric patients with CHD who underwent cardiac surgery, 92 patients met inclusion criteria in this study. The data were taken from medical records included demographic data, anthropometry, electrocardiography, surgical procedures, perioperative parameters, electrolyte levels, and management of postoperative arrhythmias. Among 92 patients, 14 (15.2%) developed postoperative arrhythmias. Complete heart block (CHB) the most common arrhythmia, observed in five patients (35.7%), followed by supraventricular tachycardia three patients (21.4%). There were statistically significant differences between arrhythmia and nonarrhythmia groups for cardiopulmonary bypass (CPB) duration (171.23 vs. 108.01 min), aortic cross-clamp duration (115.58 vs. 73.59 min), ischemia duration (106.33 vs. 65.43 min), and potassium level (3.33 vs. 3.88 mmol/L) with p < .05. Based on multivariate linear regression analysis, CPB time and potassium level were found to be independent risk factor. Early postoperative arrhythmia observed 15.2% in this study, dominated by CHB. CPB duration, aortic cross-clamping, ischemia time, and potassium level were statistically significantly different between arrhythmia and nonarrhythmia groups.

NEUROLOGICAL COMPLICATIONS FOLLOWING PEDIATRIC CONGENITAL CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives: The study was designed to ascertain the incidence of neurological complications in children following cardiac surgery for congenital heart defects (CHD). Methods: An extensive search was conducted using Medical Subject Headings in the Cochrane Controlled Trials databases, PubMed, and Embase in July 2023. Data extraction was done using a customized data extraction sheet, adhering to Cochrane’s standard methodological procedures. As the heterogeneity was high among the included studies, random-effect models were employed during the meta-analysis. Results: Seventeen articles were included in our analysis, encompassing a total sample size of 23,930 pediatric patients who underwent congenital cardiac surgeries. The calculated incidence of neurological complications following these procedures was found to be 0.21 (95% confidence interval: 0.14–0.28). A random-effects model employing the DerSimonian-Laird estimator was utilized for the meta-analysis. The assessment of heterogeneity revealed Tau of 0.134, an I2 value of 99.63%, and an H2 value of 267.078, indicating heterogeneity (p&lt;0.001). Conclusion: The study highlights the substantial incidence of neurological complications following congenital cardiac surgery, with infants &lt;1 year old being at a higher risk.

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation.

Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.

СОСТОЯНИЕ ДЫХАТЕЛЬНОЙ СИСТЕМЫ У ДЕТЕЙ С ГЕМОДИНАМИКОЙ ФОНТЕНА

Fontan procedure is a surgical operation for patients who were born with one working heart ventricle that involves complete separation of the pulmonary and the systemic circulation systems, which significantly improves their quality of life and becomes the preferred method of palliative surgery for congenital heart defects with univentricular hemodynamics. Despite all of its advantages this procedure is associated with a number of limitations dictated by the unique type of blood circulation. The uniqueness of Fontan hemodynamics lies in the fact that it is based on passive (non-pulsatile) pulmonary blood flow, which ensures gas exchange and preload of a single (systemic) ventricle. Pulmonary blood flow is determined by central venous pressure (CVP) and pulmonary vascular resistance. Therefore, systemic ventricular preload and cardiac output depend on well-running lung function coupled with low values of pulmonary vascular resistance. Various pulmonary anatomical or pathophysiological changes may compromise the optimal Fontan circulation. This bibliographical review represents currently known data on cardiopulmonary interactions within Fontan circulation, the causes for and the variants of the pulmonary dysfunction.

The Effect of Transfusion and Hypoxia on Cells in an in vitro Model of the Neurovascular Unit

Up to 57% of patients develop postoperative delirium after surgery for congenital heart defects (CHD). To reduce cerebral damage in pediatric patients during CHD surgery it is important to find out what inflicts the worse damage: would it be a systemic inflammatory response (SIR) triggered by transfusion, or hypoxia developed in non-transfused patients? In vitro evaluation of hypoxia and SIR effects on the neurovascular unit (NVU) cells might contribute to finding the answer.The aim of the study was to compare the effect of varying severity hypoxia and SIR on the functional activity of NUV cells in vitro.Materials and methods. An in vitro NVU model was designed including neurons, astrocytes and endotheliocytes. The effect of hypoxia on NVU was evaluated in the control (C) and 4 study groups (H 1–4), formed based on O₂ content in the medium. The C group NVU were cultivated in standard conditions: N₂ — 75%, O₂ — 20%, CO₂ — 5%; H1: N₂ — 99%, O₂ — 1%; H2: N₂ — 98%, O₂ — 2%; H3: N₂ — 97%, O₂ — 3%; H4: N₂ — 96%, O₂ — 4%. The significance of the differences was 0.0125. The effect of interleukin-6 (IL-6) content on NVU was measured by adding to culture medium pediatric patients’ serum with known minimal or maximal SIRS-response. The assessment was made in the Control — an intact NVU model, and 2 study groups — «Minimum» and «Maximum», i. e. samples with minimum or maximum IL-6 content in culture, respectively. The significance of the differences was 0.017. The cells were incubated at a normothermia regimen for 30 minutes. Then, the functional activity of NVU cells was evaluated by measuring transendothelial resistance (TER) for 24 hours and Lucifer Yellow (LY) permeability test at 60 and 90 minutes after the start of the experiment.Results. After incubation under hypoxic conditions, TER changes occurred in all studied groups. However, they were statistically significant only in the group with 1% oxygen content in the medium. TER decrease in this group was observed after 2, 4 and 24 hours. LY permeability also changed at 60 and 90 minutes, similarly — in NVU cultivated with 1% oxygen in the medium. Minimal TER values were documented at 4 hours after patients’ serum was added to NVU cells culture medium, and TER increased at 24 hours in both study groups. Cellular permeability to LY changed significantly after 1 hour exposure in both groups — with minimum and maximum IL-6 content in the medium. Although at 90 minutes, there was no difference between the 3 groups in LY permeability tests.Conclusion. Intensive SIR demonstrated short-term but more deleterious than hypoxia, effect on cells in the NVU model. Hypoxia disrupted functional activity of NUV cells only at 1% O₂ concentration in the medium.

To Determine the Frequency and Risk Factors for Significant Postoperative Bleeding in Children with Congenital Heart Diseases Undergoing Open Heart Surgery in a Tertiary Care Center

Aim: To determine the frequency and risk factors for significant postoperative bleeding in children with congenital heart diseases undergoing open cardiac surgery in our tertiary care hospital. Methods: A prospective observational study was carried out in the department of Paediatric cardiac intensive care Unit at National Institute of Cardiovascular diseases Karachi between [dates here].Children aged 0-18 years underwent open heart surgery for congenital heart defects. Those patients who had previous palliative surgeries for congenital heart defects were included in the study.The duration of bleeding, recurrence, and treatment given (tranexamic acid bolus/infusion, platelets, FFPs, Packed RBC/WB, Factor 7 concentrates) were also documented. The outcome of bleeding was recorded as either stopped or persistent. If bleeding persisted, any other intervention needed was also noted.

Incidence and risk factors for acute kidney injury in children with congenital heart disease undergoing cardiac surgery in a tertiary care center.

Objective: To determine the incidence and risk factors associated with acute kidney injury (AKI) in children with congenital heart diseases (CHDs) who underwent cardiac surgery in a tertiary care center. Study Design: Cross-sectional study. Setting: Paediatric Cardiac Intensive Care Unit (PCICU) of National Institute of Cardiovascular diseases, Karachi, Pakistan. Period: November 2022 to May 2023. Material &amp; Methods: We included patients of both genders and any age who underwent open or closed heart surgery for congenital heart defects. All patients undergoing CHD repairs were monitored for the total duration of PCICU stay. The development of AKI was labeled as per RIFLE criteria, and management thereafter was performed as per standard institutional protocols. Results: In a total of 93 patients with CHD, there were 50 (53.8%) males and 43 (46.2%) females. The mean age was 9.71±9.14 year ranging between 3 months to 60 years. There were 6 (6.5%) patients who developed AKI post-surgery. Overall, mortality was noted in 7 (7.5%) patients. Cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were significantly higher among patients who developed post-surgery AKI (&lt;0.001). Moreover, post-surgery AKI was significantly associated with intra-operative hypotension (p&lt;0.001), post-operative hypotension (p&lt;0.001), and post-operative sepsis (p&lt;0.001). It was also found that AKI had significant association with higher post-operative inotropic scores (p&lt;0.001), prolonged duration of mechanical ventilation (p&lt;0.001), and length of PCICU stay (p&lt;0.001). Mortality had significant association with AKI (33.3% vs. 5.7%, p=0.013). Conclusion: We noted the incidence of AKI among patient who underwent cardiac repairs to be 6.5%. CPB time and ACC time were significantly higher among patients who developed post-surgery AKI. Post-surgery AKI was significantly associated with intra-operative hypotension, post-operative hypotension, and post-operative sepsis. Mortality was significant high among cases that had AKI.

Implantation of HeartMate III ventricular assist devices in children after surgical treatment of complex congenital heart defect: first experience

Background. There is quite a high number of patients with advanced heart failure (HF) who have undergone surgical treatment for complex congenital heart defects. Implantation of mechanical circulatory support systems is the only treatment option for patients with refractory end-stage heart failure. Only a few centers have experience in implantation of ventricular assist devices (VAD) in children, which is a major challenge for modern pediatric cardiac surgery. Objective: to present our first experience of implantation of HeartMate III VADs in patients after surgical correction of complex congenital heart defects. Materials and methods. From 2021 to 2022, at Bakulev Center for Cardiovascular Surgery, four HeartMate III systems were implanted in children with advanced HF, who had previously undergone surgery for a complex congenital heart defect. In one case, aortic valve implantation was carried out simultaneously with VAD implantation. Results. All patients were discharged from the center. One patient developed right-sided heart failure intraoperatively, which required the use of a right ventricular assist device (RVAD) for 8 days. There were no complications from the central nervous system, bleeding, pump thrombosis, or infection. Conclusion. HeartMate III can be implanted in patients with body weight ≥21 kg and BSA ≥0.88 m2 . Children’s tolerance to physical activity increases, they are fully adapted socially, and can attend school.

Minimally Invasive Surgery for Simple Congenital Heart Defects: Preserving Aesthetics without Jeopardizing Patient Safety.

Minimally invasive surgeries for pediatric patients have been proposed for decades, with different approaches in mind. Minimal right axillary thoracotomy (MRAT), proposed two decades ago, allows the preservation of patients' safety alongside faster aesthetic and functional recovery. The MRAT did not become widely adopted due to the prejudice that to follow a minimally invasive approach, safety and efficacy must be compromised. With this study, we aim to compare MRAT to the standard median sternotomy approach with a focus on safety and clinical outcomes. Between January 2017 and April 2021, 216 patients diagnosed with ASD, pAVSD, or PAPVD underwent surgical repair with different approaches in the same period. MRAT was used for 78 patients, and median sternotomy was used for 138 patients. In this last group, standard median sternotomy (SMS) was used for 116 patients, while a minimal skin incision (SMS mini) was used for 22 patients. There were no major complications overall nor in each specific approach. MRAT enabled the successful repair of simple heart defects, providing similar post-operative and cardiological recovery. MRAT does not compromise patients' safety and does not prolong the duration of surgery once the learning curve is overcome, which is generally after 15-20 consecutive operations.

Predicting Surgical Mortality After Congenital Heart Surgeries Using Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) Risk Scoring System: A Retrospective Analysis in A Single Tertiary Center

Objective: The main objective of our study was to analyze the in-hospital mortality in children who underwent surgery for congenital heart defects in a single tertiary cardiac center in Nepal using RACHS-1 risk score during 6 year period. Methods: After approval from Institutional Review Board, retrospective data analysis were performed from June 2013 to June 2019 at Shahid Gangalal National Heart Centre. Patients younger than 14 years, who underwent cardiac surgery for congenital heart defects, were enrolled. Data from patient records regarding the age, gender, weight, diagnosis, procedures performed, cardio‑pulmonary bypass (CPB) time and aortic cross‑clamp (AoX) were obtained. The operations were classifed according to the six RACHS-1 categories and patients were allotted to RACHS-1 categories retrospectively by matching the procedure of each patient with a risk category. Results: Two thousand four hundred and seventeen patients underwent surgeries for congenital heart diseases who were classifed according to the RACHS‑1 score. Among the patients, 56.1 % were male and 20.1 % were younger than one year of age. The mortality was 1.5%,13.3%, 21.7% and 73.4% for category 1, 2, 3 and 4 respectively. The overall ability of the RACHS‑1 classifcation to predict in‑hospital mortality Area under the ROC curve was 0.736 with 95% confdence interval (CI) of 0.709-0.763. Conclusion: The RACHS‑1 classification is applicable to our pediatric populations which was a useful and easily applicable tool, requiring only very few data for mortality risk in our hospital although there are other factors that have an impact on the mortality.

Self-constituted modified del Nido cardioplegia solution in pediatric congenital heart defect surgery.

ABSTRACT… Objective: To present our experience of modified del Nido Cardioplegia for chemical arrest and myocardial protection during congenital heart defect in pediatric cardiac surgeries. Study Design: Retrospective Cross Sectional. Setting: Department of Cardiac Surgery, PAQSJIMS, Gambat, Khairpur. Period: 15th March, 2021 to 10th October, 2022. Material &amp; Methods: del Nido solution is generally constituted in plasma lyte A solution, not available in Pakistan; therefore, we constituted del Nido solution in ringer lactate solution. We had collected our data retrospectively for our study to assess the safety and efficacy of modified del Nido cardioplegic arrest during the open heart surgeries for congenital heart defects. We report clinical outcomes of our patients that include spontaneous rhythm, ionotropic score and duration of mechanical ventilation underwent open heart surgeries with. Results: During the study period we had performed 102 surgeries for correction or palliation of congenital heart defects. We have included 54 patients in our study co with 28 (52%) male and 26 female (48%) patients; had a mean age 8.9 (±3.7) years and mean weight 22.4 (±12.7) kg. Majority of patients 29 (54%) belonged to Category 2 on RACHS-1 scale. Our average cross clamp time was 39.7min, and 37(68%) patients required a single dose of cardioplegia. Spontaneous sinus rhythm was established in 48(89%) patients; average ionotropic score of patients at the time of PICU arrival was 8.6 (±5.6) with 31(57%) have score of less than 10, while 2(4%) patients were received without the ionotrope. All the patients were shifted on mechanical ventilators with average time of 253.6 (±219.6) min of mechanical ventilation. Conclusion: Our results show modified del Nido solution is safe, with added benefits of fewer interruption in surgery, greater magnitude of spontaneous sinus rhythm and fewer ionotropic requirements.

The Outcome of Congenital Cardiac Surgery in Patients with Down Syndrome: Single-Center Experience.

This study aimed to describe the outcomes of Down syndrome patients who underwent cardiac surgery for congenital heart defects and to develop risk prediction models for in-hospital mortality, recurrent hospital admission, and the need for catheter intervention among a cohort of patients. This single-centre retrospective cohort study included consecutive Down syndrome patients who underwent cardiac surgery for congenital heart defects between January 2018 and December 2021. We reviewed the electronic medical records. Two hundred patients fulfilled the eligibility criteria with complete data reporting. The patients' perioperative data and outcomes were recorded. Females constituted 56.5%. Most (78.5%) patients showed accepted recovery. The incidence of all-cause in-hospital mortality was 3.0%. The rates of the need for a second operation, heart failure management, and permanent pacemaker insertion were 3.0%, 2.0%, and 2.5%, respectively. Only 8 (4.0%) patients stayed in the hospital for a long duration after chylothorax or tracheostomy (if intubated more than 2 weeks). The model had an accuracy of 99% and included the intraoperative transesophageal echocardiography (TEE) abnormalities (residual heart lesions) (adjusted odds ratio [AOR]: 26.541, p = 0.033), the duration of mechanical ventilation following the operation (AOR: 1.152, p = 0.009), and the occurrence of postoperative heart block (AOR: 76.447, p = 0.005). Surgical treatment of congenital heart defects in Down syndrome patients had good outcomes with accepted recovery (without intra-hospital or during follow-up mortality or morbidity) of 78.5% and a 3% incidence of in-hospital mortality. Though, the occurrence of chylothorax was considerably high, and resulted in a long hospital stay (more than 10 days). Repair of tetralogy of Fallot and coarctation of the aorta were associated with an increased likelihood of catheter intervention following the operation.