Cirugía congénitos

Pediatr Dev Pathol. 2025 Oct 3:10935266251366015. doi: 10.1177/10935266251366015. Online ahead of print.

ABSTRACT

Left pulmonary artery (LPA) sling is a rare congenital anomaly in which the LPA abnormally originates from the right pulmonary artery (RPA) and courses between the trachea and esophagus to reach the left pulmonary hilum. This anomaly is frequently associated with tracheobronchial and other cardiovascular anomalies and patients may manifest with varying airway and cardiovascular symptoms. Surgical repair is often required for symptomatic patients. Clinical outcomes largely depend on the extent and severity of coexisting anomalies, particularly tracheobronchial abnormalities. We report 2 autopsy cases of LPA sling, 1 pre- and 1 post-surgical repair. Comprehensive autopsy examination was crucial for confirmation of the clinical diagnoses and identification of a rare surgical complication.

PMID:41042052 | DOI:10.1177/10935266251366015

JAMIA Open. 2025 Oct 1;8(5):ooaf106. doi: 10.1093/jamiaopen/ooaf106. eCollection 2025 Oct.

ABSTRACT

OBJECTIVES: Accurate characterization of patients with congenital heart disease is fundamental to research, outcomes reporting, quality improvement, and clinical decision-making. Here we present an approach to computing the anatomy of patients with congenital heart disease based on the whole of their diagnostic and surgical codes.

MATERIALS AND METHODS: All diagnostic and procedure codes for patients cared for between 1981 and 2020 at Boston Children's Hospital were extracted from a database containing diagnostic codes from echocardiograms, and procedural codes from surgical and catheterization procedures. The pipeline sequentially (1) mapped each of the 7500 native codes to algorithm codes; (2) computed the parent anatomy for each study using a pre-defined hierarchy; (3) computed the parent anatomy for the patient, based on highest ranking parent anatomy; and (4) computed the subcategories and mandatory co-variate findings for each patient. Thereafter, diagnostic accuracy of 500 unseen patients was adjudicated against clinical documentation by clinical experts.

RESULTS: A total of 514 541 echocardiograms on 161 735 patients were available for this study. Phenotypes of congenital cardiac diseases were assigned in 84 285 patients (52%), and the remainder were computed to have normal anatomy. Clinicians agreed with algorithm assignments in 96.4% (482 of 500 patients), with disagreements most often representing definitional differences. An interactive dashboard enabled by the output of this algorithm is presented.

CONCLUSIONS: The computation of detailed congenital heart defect phenotypes from raw diagnostic and procedure codes is possible with a high degree of accuracy and efficiency. This framework may enable tools to support interactive outcomes reporting and clinical decision support.

PMID:41041623 | PMC:PMC12486236 | DOI:10.1093/jamiaopen/ooaf106

J Soc Cardiovasc Angiogr Interv. 2025 Aug 19;4(9):103804. doi: 10.1016/j.jscai.2025.103804. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Although adverse events (AEs) are common during congenital cardiac catheterization procedures, many have little impact beyond the catheterization laboratory. We sought to identify factors that are associated with an increased length of stay (LOS).

METHODS: A total of 10,882 cases from the C3PO-quality improvement registry dataset from January 2014 to December 2017 admitted electively on the same day of cardiac catheterization were analyzed and independent risk factors for a prolongation of LOS were identified.

RESULTS: Length of stay ranged from 0 to 305 days. The incidence of higher severity AE was significantly higher for cases that had a hospital stay of 2 days or more, compared to those discharged the same day or day 1 after the procedure (15% vs 2%, P < .001). Seven percent of patients without any AE in the cardiac catheterization laboratory had a prolonged LOS of 2 days or more. Significant independent risk factors for a prolongation of LOS included age <1 year, single ventricle diagnosis, cardiac surgery within the last 90 days, a higher hemodynamic vulnerability score, a higher PREDIC3T risk category, a prolonged procedure time, contrast usage >6 mL/kg, operators experience of either <5 or ≥25 years, and operator case volume >200 cases/y. The presence of any level 3bc, 4, or 5 AE had the highest associated odds of an increased LOS (OR, 5.9; 95% CI, 4.6-7.6).

CONCLUSIONS: Prolonged admission after outpatient catheterization is a potential alternative measure of safety after pediatric or congenital cardiac catheterization. It is independently associated not only with patient, procedure, and operator factors that have previously been described to be associated with the risk of AE but also with other factors such as the presence of single ventricle physiology. Further studies are needed to further evaluate its utility.

PMID:41040445 | PMC:PMC12485507 | DOI:10.1016/j.jscai.2025.103804

Front Cardiovasc Med. 2025 Sep 17;12:1615697. doi: 10.3389/fcvm.2025.1615697. eCollection 2025.

ABSTRACT

BACKGROUND: Cardiopulmonary bypass (CPB) in paediatric open-heart surgery is challenging, especially in neonates and aortic arch surgery. It induces a systemic inflammatory response that can lead to significant postoperative complications, including multiorgan dysfunction, prolonged mechanical ventilation, and intensive care unit (ICU) stay. Blood purification with hemoadsorbers integrated into CPB has been proposed as a strategy to reduce these side effects. These devices adsorb cytokines from the bloodstream, trying to modulate their negative systemic effect.

METHODS: This retrospective study evaluates 33 neonates who underwent complex cardiac surgeries between January 2022 and January 2025 at Regina Margherita Children's Hospital. 17 of them had been treated with Jafron HA60 hemoadsorber during CPB. Biomarkers of organ damage (creatinine, lipase, aspartate transaminase, and alanine transaminase), C-reactive protein, lactates, inotropic drugs doses and a wide range of pro- and anti-inflammatory cytokines were analysed during surgery and in the intensive care unit.

RESULTS: The results showed a decrease in biomarkers of organ damage and inflammation, accompanied by a tendency toward reduction in the required dose of inotropes, ICU stays, days of mechanical ventilation, and duration of required open chest time in the treated group. A similar downward pattern was observed in cytokine levels.

CONCLUSIONS: Hemoadsorption may be associated with improved clinical parameters in neonates undergoing high-risk cardiac surgery. Further large-scale studies are needed to explore these observations.

PMID:41040072 | PMC:PMC12484163 | DOI:10.3389/fcvm.2025.1615697

Innovations (Phila). 2025 Oct 3:15569845251375996. doi: 10.1177/15569845251375996. Online ahead of print.

NO ABSTRACT

PMID:41040037 | DOI:10.1177/15569845251375996

BMC Pediatr. 2025 Oct 2;25(1):727. doi: 10.1186/s12887-025-06094-6.

ABSTRACT

BACKGROUND: Oxygen saturation (SpO₂) is a crucial parameter for monitoring the health of cardiac patients. It measures the percentage of hemoglobin in the blood that is saturated with Oxygen. The study aims to analyze longitudinal Oxygen saturation (SpO2) levels and identify its determinants among cardiac patients.

METHODS: Bayesian linear mixed-effects model with the asymmetric generalized error distribution (AGED) was used to analyze the data. The data comprises 323 children diagnosed with cardiac disease. AGED outperforms the others distributions and indicates robust and effective choice to analysis the data.

RESULTS: The estimated shape parameters of AGED are significant [Formula: see text] (95% CI: 2.31, 2.58) which is degree of asymmetry, and [Formula: see text] (95% CI: 3.18, 3.46) is associated with peakedness of the distribution. The finding reveals that corrective surgery, pulmonary hypertension, cardiomyopathy, anemia, nutritional status, and hemoglobin levels are significantly associated with Oxygen saturation (SpO2). Pulmonary hypertension, cardiomyopathy, and under nutrition are found to lower SpO2. In contrast, higher hemoglobin and corrective surgery are significantly associated with higher SpO2. The AGED fitted to the data, and found to be important for analyzing data characterized by asymmetry and excess kurtosis.

PMID:41039283 | PMC:PMC12492735 | DOI:10.1186/s12887-025-06094-6

Rev Esp Cardiol (Engl Ed). 2025 Sep 30:S1885-5857(25)00271-3. doi: 10.1016/j.rec.2025.09.011. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Transcatheter patent ductus arteriosus (PDA) closure is safe in < 2-kg infants and in ≥ 6-kg patients, but major safety concerns remain when applied to the intermediate weight range. We aimed to assess outcomes of transcatheter PDA closure in 2- to 6-kg infants.

METHODS: An international, multicenter, retrospective cohort study was conducted in 31 tertiary hospitals in 17 countries between 2000 and 2023, investigating all infants who underwent attempted transcatheter PDA closure with a procedural weight of 2-to-6 kg.

RESULTS: Attempted transcatheter PDA closure was performed in 1231 infants (median [Q1-Q3] weight, 4747 [ 3700-5300] g; median age, 132 [ 83-194] days; ex-preterm, n = 581 [56.8%]) with a 95.0% success rate. A composite outcome of procedural failure or major adverse events was observed in 173 (14%) patients, including device embolization in 64 (3.7%), device-induced left pulmonary artery stenosis in 47 (2.7%), and procedural death in 2 (0.2%). Logistic regression model analysis identified a 2- to 3.9-kg procedural weight, increased pulmonary artery pressure, and window-type or tubular ductal morphologies as independent predictors of the composite outcome. Based on propensity score matching analysis, 2- to 3.9-kg infants had a risk ratio of 2.19 (95%CI, 1.25-3.83) for experiencing the composite outcome, compared with 4- to 5.9-kg infants.

CONCLUSIONS: Transcatheter PDA closure in 2- to 6-kg infants was feasible in most patients. Procedural failure or major adverse events occurred in 14% and several independent risk factors were identified, including the 2- to 3.9-kg weight range identified as a higher-risk subgroup. These findings may improve risk stratification and the decision-making process.

PMID:41038445 | DOI:10.1016/j.rec.2025.09.011

Pediatr Radiol. 2025 Oct 2. doi: 10.1007/s00247-025-06412-1. Online ahead of print.

ABSTRACT

A life-threatening chylothorax developed in a female neonate after corrective surgery of d-transposition of the great arteries complicated by extensive postoperative thrombosis of the superior vena cava distribution, including at the thoracic duct-venous junction. Emergent percutaneous catheter intervention for thrombus aspiration and transluminal angioplasty was required. Despite therapeutic heparinization, thrombosis persisted. Curative image-guided treatment was twofold: first, the occluded thoracic duct was punctured under ultrasound guidance; then, the thrombus at the thoracic duct-venous junction was mobilized using the Seldinger-technique. Additionally, a venous catheter was placed with the tip at the thoracic duct-venous junction, and local low-dose thrombolysis was administered. This case shows that it is possible to percutaneously access the thoracic duct by direct puncture in a neonate with ultrasound guidance.

PMID:41037148 | DOI:10.1007/s00247-025-06412-1

Int J Cardiol Congenit Heart Dis. 2025 Aug 27;22:100617. doi: 10.1016/j.ijcchd.2025.100617. eCollection 2025 Dec.

ABSTRACT

OBJECTIVE: This study evaluated thrombus formation and its impact on outcomes in neonates and early infants undergoing congenital heart surgery.

METHODS: Neonates and early infants (≤90 days) undergoing congenital heart surgery with cardiopulmonary bypass from 2001 to 2024 were analyzed. Thrombi were detected by transthoracic echocardiography and cardiac catheterization.

RESULTS: Among 2331 patients, 170 (7.3 %) developed thrombi during hospitalization. Median age at surgery and time to thrombus detection in affected patients were 12 (interquartile range: 7-34) and 7 (interquartile range: 3-15) days, respectively. Among surgical procedures performed in at least 10 patients, thrombi were most frequently observed following tricuspid valve repair (28.6 %), followed by arterial switch operation, ventricular septal defect closure, and aortic arch repair (15.8 %). The most common thrombus location was the superior vena cava in 61 patients, followed by the inferior vena cava in 33, the aorta in 31, and the right atrium in 21 patients. Additional surgical interventions were required in 28 patients. The length of hospital stay was significantly longer in patients with thrombi (27 vs. 15 days, p < 0.001). Independent risk factors for thrombus formation included preoperative cardiopulmonary resuscitation (odds ratio: 2.037, p = 0.001), tricuspid valve repair (odds ratio: 6.206, p < 0.001), and Norwood procedure (odds ratio: 1.558, p = 0.027).

CONCLUSIONS: The incidence of thrombus formation was 7.3 % in neonates and early infants undergoing congenital heart surgery. Thrombus was most frequently observed in the superior vena cava and resulted in prolonged hospitalization. Preoperative cardiopulmonary resuscitation, tricuspid valve repair, and Norwood procedures carried the highest thrombotic risk.

PMID:41035781 | PMC:PMC12483653 | DOI:10.1016/j.ijcchd.2025.100617

Pediatr Res. 2025 Oct 1. doi: 10.1038/s41390-025-04443-w. Online ahead of print.

ABSTRACT

BACKGROUND: Early echocardiographic characteristics (EC) of congenital diaphragmatic hernia (CDH) neonates and their associations with outcomes, especially differences by laterality and size, are unknown.

METHODS: Congenital Diaphragmatic Hernia Study Group data between 2015 and 2020 were used. Early postnatal EC, including atrial and ductal shunt direction, pulmonary hypertension (PH) severity, and ventricular size and function, were assessed based on defect laterality and size. Outcomes included mortality and extracoporeal life support (ECLS) use.

RESULTS: The study population included 1777 infants. Severe PH, right-to-left shunt, left ventricular (LV) hypoplasia, right ventricular dilation, and ventricular dysfunction were more prevalent in larger defects. Independent of defect size, neonates with R-CDH had more severe PH, more bidirectional and right-to-left atrial shunt, and more biventricular (BV) dysfunction. In contrast, L-CDH neonates had more LV hypoplasia and left-to-right atrial shunt. After adjusting for defect side, larger defects were associated with LV hypoplasia and right-to-left and bidirectional atrial shunt. In multivariate analysis, right-to-left atrial shunt and BV dysfunction were associated with increased mortality, whereas bidirectional atrial shunt and BV dysfunction were associated with ECLS use.

CONCLUSIONS: CDH neonates are at increased risk for early cardiac dysfunction. EC differ by laterality and size. Management of cardiac dysfunction in CDH may improve outcomes.

IMPACT: Cardiac dysfunction has emerged as a factor contributing to adverse outcomes in congenital diaphragmatic hernia (CDH). However, there are limited data on the impact of defect size, laterality, and severity of postnatal cardiac dysfunction on outcomes. Echocardiographic characteristics in the first two days of life differ by defect laterality and size. Right-to-left atrial shunt and biventricular dysfunction are associated with increased mortality. Bidirectional atrial shunt and biventricular dysfunction were associated with extracorporeal life support use. Our results support the need for standardized cardiac function assessment in critically ill neonates with CDH. Future strategies to identify and manage these diverse hemodynamic profiles are needed to improve outcomes.

PMID:41034644 | DOI:10.1038/s41390-025-04443-w

Pediatr Cardiol. 2025 Oct 1. doi: 10.1007/s00246-025-04049-3. Online ahead of print.

ABSTRACT

Arginine-vasopressin (AVP) stimulates adrenocorticotropic hormone (ACTH) secretion and may contribute to the stress response after surgery. Its endocrine effects in children undergoing congenital heart surgery remain unclear. We prospectively evaluated 49 children (median age 8 months, IQR 5-59 months; median weight 11.0 kg, IQR 7.2-26.3 kg) after corrective cardiac surgery with cardiopulmonary bypass. Patients receiving AVP within 48 h postoperatively (n = 23) were compared with those not treated (n = 26). Baseline hormone levels (AVP, ACTH, cortisol, cortisol-binding globulin) were measured. Serial cortisol, ACTH, sodium, and glucose levels were analyzed. Time-series linear regression models examined associations between AVP therapy and adjusting for covariates such as cortisol, ACTH, CBG, and AVP levels. Baseline did not differ between groups. AVP therapy was not associated with significant differences in ACTH or cortisol over time. A non-significant trend toward higher cortisol was observed in AVP-treated patients. Regression analyses demonstrated significant associations between ACTH and cortisol (coefficient = 0.0325, p < 0.01), cortisol and systolic blood pressure (coefficient = 0.005, p < 0.01), and baseline AVP level with systolic blood pressure (coefficient = 0.003, p < 0.01) and renal oxygen extraction ratio (coefficient = 0.124, p = 0.01) and hormone levels. In this prospective cohort of children after congenital heart surgery, AVP therapy did not significantly alter ACTH or cortisol levels. Cortisol and baseline AVP levels were independently associated with hemodynamic markers. These findings suggest that the hemodynamic benefit of AVP is unlikely to be mediated through hypothalamic-pituitary-adrenal axis activation. Larger studies are needed to confirm these results.

PMID:41034421 | DOI:10.1007/s00246-025-04049-3

Pediatr Cardiol. 2025 Oct 1. doi: 10.1007/s00246-025-04038-6. Online ahead of print.

ABSTRACT

Systemic sirolimus (SS) is an mTOR inhibitor used in the management of pediatric intraluminal pulmonary vein stenosis (PVS). SS initiation, monitoring, including patient compliance with toxicity surveillance, and potential adverse events (AE) in PVS patients are under reported. A single-center retrospective cohort study of consecutive patients who were initiated on SS for PVS from January 1, 2020 to December 31, 2024 was performed. Fifty patients with a median age of 7 months (range 2-165) received SS for PVS (median number of stenotic veins; n = 3 (1-4)) for a median duration of 18 months (1-60). The median time to therapeutic level was 9 days [IQR 3, 20] with two never achieving therapeutic values. In patients who received SS for at least 6 months (n = 39), the median number of blood draws and number of dose adjustments in the first 6 months were 14 [IQR 5, 27] and 3 [1, 7], respectively. Most levels among patients (75%; [IQR 64, 84]) did not require a dose adjustment. Toxicity surveillance compliance increased from 58% [IQR 42, 83] to 79% [IQR 62.5, 92] (p = 0.22) following transitioning ownership of SS management to a dedicated PVS team. Eighteen percent (9/50) of patients had an AE potentially related to SS; SS was discontinued in three. PVS patients receiving SS have high, but variable rates of therapeutic levels and SS discontinuation due to AEs is uncommon. Compliance with safety labs may improve with ownership by a dedicated monitoring team.

PMID:41034420 | DOI:10.1007/s00246-025-04038-6

Int Heart J. 2025;66(5):805-812. doi: 10.1536/ihj.25-244.

ABSTRACT

Although the safety and efficacy of transcatheter atrial septal defect (ASD) closure has been reported in elderly patients, postprocedural outcomes in elderly patients with long-standing persistent atrial fibrillation (AF) have not been fully assessed. The aim of this study was to elucidate the cardiac remodeling process and symptom improvement after transcatheter ASD closure in elderly patients with AF (AF-ASD) compared to those in sinus rhythm (SR-ASD).We enrolled 52 patients aged > 70 years out of 253 consecutive patients who underwent transcatheter ASD closure. We retrospectively analyzed serial echocardiograms, New York Heart Association (NYHA) functional classification, and plasma brain natriuretic peptide (BNP) levels from baseline to 1 year after the procedure.With respect to the right-sided chambers, significant reverse remodeling began immediately after the procedure and continued in both groups up to 1 year after the procedure. Left ventricular augmentation was comparable in both groups. Left atrial volume increase was prominent in the AF-ASD group, with a statistically significant difference compared with the SR-ASD group from 2 days to 1 year after the procedure (all P < 0.05). NYHA functional classification improved in both groups. Plasma BNP levels decreased only in the AF-ASD group from baseline to 1 year (median value [interquartile range], 336.2 pg/mL [145.1-491.4] to 173.8 pg/mL [73.6-261.7], P = 0.032).Transcatheter ASD closure is an effective treatment for heart failure in elderly patients with ASD and long-standing persistent AF.

PMID:41034026 | DOI:10.1536/ihj.25-244

World J Pediatr Congenit Heart Surg. 2025 Oct 1:21501351251375444. doi: 10.1177/21501351251375444. Online ahead of print.

ABSTRACT

Objectives: This study aimed to report the incidence of cardiac arrest and in-hospital mortality after pediatric congenital heart surgery in a middle-income country. Methods: This retrospective cohort study was conducted in Thailand. Patients <18 years of age who underwent congenital heart surgery between 2014 and 2019 and experienced cardiac arrest following surgery during the same hospital stay were included. We examined the characteristics of patients who experienced cardiac arrest and its management to determine the mortality-associated factors following cardiac arrest. Results: Overall, 116 cases of cardiac arrest following 1,928 congenital heart surgery operations were included, which resulted in 93/116 (80%) deaths. The incidence of cardiac arrest and in-hospital mortality per 100 patients (95% confidence interval) were 6.0% [116/1,928 (5.0%-7.2%)] and 4.8% [93/1,928 (4.0%-5.9%)], respectively. The incidence of cardiac arrest was higher in neonates (33.6%, 47/140), high-risk STAT 5 surgery (54.8%, 23/43), and emergent/urgent surgery (25.4%, 81/319). Most cardiac arrests occurred within 24 h (66/116, 57%) and in the intensive care unit (90/116, 78%). The most common cause of cardiac arrest was cardiovascular-related (74.1%, 86/116). Multivariable analysis showed the factors associated with mortality (adjusted odds ratio, [95% confidence interval]) included cardiac arrest after 72 h (5.594 [1.073-29.167]), multiple cardiac arrests (10.231 [1.884-55.566]), and every minute increase in cardiopulmonary resuscitation (1.027 [1.005-1.048]). Conclusions: Congenital heart surgery at our middle income cardiac surgical center was associated with relatively high incidence rates of cardiac arrest and in-hospital mortality, and a very high mortality rate following cardiac arrest. The mortality-associated factors after cardiac arrest were cardiac arrest after 72 h, multiple cardiac arrests, and longer duration of cardiopulmonary resuscitation.

PMID:41032652 | DOI:10.1177/21501351251375444

Anesth Analg. 2025 Oct 1. doi: 10.1213/ANE.0000000000007754. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have shown that regional anesthesia (RA) use versus placebo control is associated with less postsurgical opioid requirements and improved pain scores. This trial compared a novel combination of bilateral pecto-intercostal fascial plane and unilateral rectus sheath blocks to an active comparator of surgeon-administered local anesthetic wound infiltration in children undergoing septal defect repair. The study tested the hypothesis that RA use would result in less opioid use and lower pain intensity compared to wound infiltration.

METHODS: This double-blind, randomized, parallel group, single-center trial included children (<18 years) undergoing primary atrial septal defect (ASD) or ventricular septal defect (VSD) repair. Participants were randomized to RA consisting of ultrasound-guided pecto-intercostal fascial plane and rectus sheath blocks or no-block, consisting of local anesthetic wound infiltration. Both groups received 1.5 mL/kg of ropivacaine 0.2% for the intervention. The primary outcome was opioid use (oral morphine milligram equivalents [MME]/kg) 0-12 hours after surgery. Secondary outcomes were opioid use at additional time points, pain (0-10 scale) between 0 and 48 hours (area under the curve [AUC]), and hospital length of stay (LOS).

RESULTS: Data analysis included 42 children (24 RA, 18 infiltration), age 3.3 ± 2.7 years (mean ± standard deviation [SD]; median, 3; range, 4 months-10 years). Opioid use (MME/kg mean ± SD) 0-12 hours after surgery was 0.44 ± 0.19 in the RA group compared to 0.83 ± 0.39 in the infiltration group (mean difference -0.39; 95% confidence interval [CI], -0.59 to -0.18; P = .001). Total postoperative opioid use from 0 to 48 hours after surgery was 0.95 ± 0.40 in the RA group compared to 1.57 ± 0.75 in the infiltration group (mean difference -0.64; 95% CI, -1.02 to -0.22, P = .004). Pain intensity AUC (0-48 hours) was 45.0 ± 26.8 in the RA group compared to 94.5 ± 55.7 in the infiltration group (mean difference -49.5 [-78.9 to -20.1]; P = .002). Opioid use between 12 and 48 hours and hospital LOS was not different between groups.

CONCLUSIONS: This single-center study showed that the combined pecto-intercostal fascial plane and rectus sheath blocks were opioid-sparing and provided superior pain control compared to contemporary practice of local anesthetic infiltration in children following septal defect repair. This investigation strengthens the evidence to support RA use to improve postoperative pain in this population.

PMID:41032451 | DOI:10.1213/ANE.0000000000007754

Cureus. 2025 Aug 30;17(8):e91294. doi: 10.7759/cureus.91294. eCollection 2025 Aug.

ABSTRACT

Pediatric thoracic surgery has undergone significant changes and improvements due to the evolution of minimally invasive techniques, robotic-assisted interventions, and enhanced patient care. Enhanced thoracic surgical interventions progressed in pediatric thoracic tumors, airway management, chest wall reconstruction, and lung transplantation. Key areas for improvement include the adoption of enhanced recovery protocols, enhancing long-term outcomes, and integrating emerging technologies such as 3D printing and artificial intelligence. Despite the advancement in these fields, challenges still exist, underscoring the importance of high and specialized training, multidisciplinary collaboration, and future and continued research to optimize patient outcomes and shape the future of pediatric thoracic surgery. Emerging evidence supports standardized perioperative pathways tailored to children, including multimodal opioid-sparing analgesia, early mobilization, and proactive pulmonary physiotherapy. Advances in imaging and intraoperative navigation are refining lesion localization and resection margins while minimizing collateral trauma. Simulation-based training, competency benchmarks, and international registries can consolidate quality and safety. Equitable access across resource-limited settings, family-centered care, and long-term surveillance for functional, psychosocial, and oncologic outcomes remain priorities. Finally, telemedicine-enabled follow-up and data-driven decision support promise precision and continuity of care.

PMID:41030723 | PMC:PMC12478633 | DOI:10.7759/cureus.91294

Interdiscip Cardiovasc Thorac Surg. 2025 Oct 6;40(10):ivaf212. doi: 10.1093/icvts/ivaf212.

ABSTRACT

Surgical innovation through first-in-human (FIH) procedures, such as partial heart transplantation, plays an important role in advancing clinical care. However, these procedures frequently proceed without formal ethical oversight. We conducted a systematic PubMed search yielding 48 FIH congenital cardiac case reports (1990-2025), then screened each article for 10 predefined oversight-related terms covering regulatory bodies, ethics, and innovation boards. Only 15 procedures (30.6%) documented any oversight language. Although recent innovations demonstrate a modest increase in formal oversight, there remains a paucity of structured review for these novel procedures. These findings highlight persistent gaps in the governance and transparency of high-risk surgical innovation.

PMID:41029027 | PMC:PMC12500323 | DOI:10.1093/icvts/ivaf212

BMC Cardiovasc Disord. 2025 Sep 29;25(1):707. doi: 10.1186/s12872-025-05189-3.

ABSTRACT

INTRODUCTION: Cardiac disease (CD) is a leading cause of death worldwide. Longitudinal studies often involve multiple patient biomarkers measured over time. Simultaneous monitoring of these biomarkers alongside time-to-death outcomes is crucial for understanding disease progression and informing clinical decision-making.

METHODS: This study apply Bayesian joint model (BJM) to analyze multiple longitudinal biomarkers alongside time-to-death data and identify factors influencing the survival of cardiac patients. The data comes from Cardiac Center-Ethiopia, which comprises 323 children diagnosed with cardiac disease. The data contains biomarkers; systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) alongside time-to-death outcomes.

RESULTS: The Bayesian Joint Model with current value and slope association structures provided the best fit for the data. The findings indicated that both the current levels and the rate of change in biomarkers were significantly associated with patient survival. Lower biomarker levels were linked to a higher probability of survival, whereas elevated levels were associated with an increased risk of mortality. Factors such as low oxygen saturation, uncorrected cardiac surgery, reduced ejection fraction, and lower hemoglobin levels negatively impacted biomarker profiles and shortened survival time. Additionally, patients with congenital heart conditions and those experiencing undernutrition exhibited lower survival probabilities.

CONCLUSIONS: The findings underscore the crucial role of identifying and utilizing biomarkers to improve survival of patients. We recommend the use of BJM with current value and slope association structures for analyzing longitudinal and time-to-event data to identify factors influencing the survival of patients.

PMID:41023812 | PMC:PMC12482821 | DOI:10.1186/s12872-025-05189-3

Sci Rep. 2025 Sep 30;15(1):33811. doi: 10.1038/s41598-025-02542-6.

ABSTRACT

The pathogenesis of NEC in term infants with critical congenital heart defects (CHD) is mainly associated with hypoxic-ischemic events that initiate an exaggerated systemic inflammatory response. Herein, we investigated the cumulative impact of the cytokine landscape and gut microbiota on the pathobiology leading to NEC onset in term newborns with CHD. This study involved 36 newborns who underwent surgical correction of CHD during the first two weeks of life; eight of them developed NEC within one week after cardiac surgery. Blood and fecal samples were collected at two time points: before and after surgery. Newborns without NEC exhibited significant changes in the levels of 22 cytokines, whereas newborns with NEC had changes in only 4 cytokines during the perioperative period. A panel including IL-1RA, IL-5, IL-18, and MCP-1 showed impressive test performance characteristics for diagnosing NEC at the preclinical stage with an AUC of 0.938, a sensitivity of 100.0%, and a specificity of 85.7%. Fifteen bacterial taxa were differentially abundant between feces samples of newborn groups. The pathobionts Collinsella and Mediterraneibacter gnavus group, known to be associated with increased intestinal permeability, were enriched in NEC newborns' feces before cardiac surgery. Our study demonstrated that the gut microbiota mediates the equilibrium of cytokine network dynamics under a broad spectrum of "friend or foe" conditions, effectively suppressing excessive inflammatory responses during early postnatal adaptation. In contrast, under conditions of low microbial diversity, a strong imbalanced cytokine feedback loop formed, resulting in deviations from normal immune response maturation. These findings offer new insights into understanding the fine-tuning of gut microbiota-immune system interactions in the first days of life.

PMID:41028028 | PMC:PMC12484952 | DOI:10.1038/s41598-025-02542-6

J Pediatr Psychol. 2025 Sep 30:jsaf089. doi: 10.1093/jpepsy/jsaf089. Online ahead of print.

ABSTRACT

OBJECTIVE: To gather parents' perspectives on the experiences of siblings of young children with congenital heart disease (CHD), the impact of CHD on siblings, and the types of resources and supports they need to adjust to CHD within their family.

METHODS: A community advisory council guided the study. Parents of children with CHD, currently 1-7 years old, who had surgery in their first year of life, were eligible for participation if they were fluent in written English and had internet access. Recruitment through several CHD-specific nonprofit organizations produced a national sample of parents (N = 108). Of the 73 who had non-bereaved heart-healthy children, 59 (81%) provided sibling-relevant data for this study. Most parents were non-Hispanic White (n = 54; 91.5%) mothers (n = 41; 69.5%; Mage = 36.10; SDage = 5.0) reporting on siblings older than the child with CHD (n = 44; 74.6%). Data were qualitative, collected through crowdsourcing, and coded to distill themes.

RESULTS: Three themes emerged: (1) CHD directly affects siblings' psychosocial functioning and daily activities, (2) CHD alters roles and relationships within the family, with impacts to siblings, and (3) families seek and appreciate support for heart-healthy siblings from extended family and friends, the healthcare team, and the community, but resources are variable.

CONCLUSION: Parents described specific ways that CHD impacts their heart-healthy children, including their psychosocial functioning, role in the family, and support from the community. Findings highlight the need for family-centered care in CHD, including screening to identify siblings at risk for psychosocial difficulties and provision of appropriate supports to meet sibling and family needs.

PMID:41027595 | DOI:10.1093/jpepsy/jsaf089