Neurocognitive Disorders Amongst Patients with Congenital Heart Disease Undergoing Procedures in Childhood
Increased surgical complexity, male sex and younger AAI were associated with increased risk of NCDs in pediatric CHD patients. Surveillance protocols should be considered to identify NCDs in CHD patients after cardiac intervention.
Does A Balanced Colloid Decrease Perioperative Blood Loss in Paediatric Cardiac Surgery: A Double-Blinded Randomized Controlled Trial?
The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products.
Accidental Systematic Administration of 1 Litre of Cardioplegia Solution during Paediatric Cardiac Surgery
The systemic administration of cardioplegia solution is a rare but important iatrogenic clinical emergency that anaesthetists working in cardiac centres should be aware of. This case demonstrates that full recovery is possible.
Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery
Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.
Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery
Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass.
Serum Metabolic Profile of Postoperative Acute Kidney Injury Following Infant Cardiac Surgery with Cardiopulmonary Bypass
Moderate-to-severe AKI after infant cardiac surgery is associated with changes in the serum metabolome, including prominent changes to purine, methionine, and kynurenine/nicotinamide metabolism. A portion of infants with mild AKI demonstrated similar metabolic changes, suggesting a potential role for metabolic analysis in the evaluation of lower stage injury.
Optimization of CPB Circuits and Techniques Minimize the Total Number of Intraoperative Emboli Delivery in Congenital Heart Surgery Patients
In summary, the generation and delivery of microemboli during CPB procedures are multifactorial and multidisciplinary. Therefore, the solutions to this significant problem should also be multidisciplinary. Optimization of CPB circuitry and techniques are necessary to minimize intraoperative injuries during pediatric cardiac surgery.
First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting
CKCV Database has a great potential for nationwide quality improvement studies. Users could instantly analyze and compare their results to national and international aggregate data using a real-time online reporting function. This is the first multicenter congenital database study in Turkey.
Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Japan and Europe
The distribution of the benchmark procedures and age at the time of surgery differ between Japan and Europe. Postoperative length of stay is longer, and the mean complexity is higher in Japan compared to European data. These comparisons of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.
Influence of Administration of Mesenchymal Stromal Cell on Pediatric Oxygenator Performance and Inflammatory Response
The administration of mesenchymal stromal cells does not interfere with oxygenator function. Allogeneic mesenchymal stromal cells show no immunogenicity, and increase plasma IL-6 level during ex vivo circulation. Further investigation is necessary to determine the effect of mesenchymal stromal cell delivery through CPB during pediatric cardiac surgery.
The Complex Nature of Emboli Detection During Cardiac Procedures
Certainly, as the letter authors stated, emboli source and delivery during surgical procedures is complex. Multidisciplinary teams are needed to solve this problem. We are glad that a robust body of literature precedes us and that the relatively small but extremely important research community represented by World Journal for Pediatric and Congenital Heart Surgery readers will continue to work together toward improving technology to accurately identify emboli burden and characteristics during cardiac procedures.
Minimally Invasive Cardiac Surgical Procedures in Children
In this summary we will review the approaches that have been described and comment on the evidence that they achieve the desired goal of minimizing the trauma of the surgical procedure and enhancing recovery.
Clinical and Hematological Outcomes of Aminocaproic Acid Use During Pediatric Cardiac ECMO
ACA administration was not associated with specific adverse effects. A clinically significant reduction in bleeding amount, red blood cell transfusions, and other hematologic interventions occurred following ACA administration for pediatric patients on ECMO. Wider consideration for ACA use as a part of a multipronged strategy to manage bleeding during ECMO should be considered.
Nnemo (Neonatal Neuromonitor) – A Hybrid Optical System to Characterize Perfusion and Metabolism in The Newborn Brain
Optical measures of perfusion and metabolism show potential to act as prognostic markers of injury and could aid clinicians in patient management before significant damage persists.
Vancomycin Concentrations During Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A Prospective Study
An AUCintra/MIC ⩾400 target was not reached in one-quarter of children undergoing heart surgery. Vancomycin peaked before the start of surgery and neonates were those with the lowest troughs. Vancomycin concentrations are affected by CPB hemodilution and by patients’ age and weight.
Basics of Extra Corporeal Membrane Oxygenation: A Pediatric Intensivist’s Perspective
This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
A Cardiopulmonary Bypass Strategy to Support A Patient with Vein of Galen Malformation
We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation.
Timeout Procedure in Paediatric Surgery: Effective Tool or Lip Service? A Randomised Prospective Observational Study
Errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.
Thromboelastography During Rewarming for Management of Pediatric Cardiac Surgery Patients
Lower MA during rewarming is associated with increased risk of perioperative bleeding. In patients with rewarming MA<45mm, intraoperative platelet transfusion may reduce the risk of subsequent bleeding. Individualized platelet transfusion therapy based on rewarming TEG may reduce the risk of bleeding while minimizing unnecessary platelet transfusion.
Cardiopulmonary Bypass in A Child with Severe Factor XII Deficiency
We report the case of a 14.7 kg girl undergoing CPB with a pre-admission FXII concentration of <1% and aPTT >200 seconds. The child was transfused with fresh-frozen plasma to replenish FXII, allowing safe ACT monitoring of heparin anticoagulation throughout CPB.
Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass
Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.
Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality
The updated STAT metrics reflect contemporary practice and outcomes. New empirically based STAT 2020 Scores and Category designations are assigned to a larger set of procedure codes, while accounting for risk associated with multiple component operations. Updating STAT metrics based on contemporary outcomes facilitates accurate assessment of case mix.
Cardiac Biomarkers for Risk Stratification of Acute Kidney Injury After Pediatric Cardiac Surgery
Preoperative plasma galectin-3 and NTproBNP and the first postoperative galectin-3 and ST2 levels were independently associated with AKI in children ≥2 years old. The performance of cardiac biomarkers after cardiac surgical procedure is affected by age, and research is required to develop biomarkers for children <2 years old.
