Tissue Engineered Transcatheter Pulmonary Valved Stent Implantation: Current State and Future Prospect

Patients with the complex congenital heart disease (CHD) are usually associated with right ventricular outflow tract dysfunction and typically require multiple surgical interventions during their lives to relieve the right ventricular outflow tract abnormality. Transcatheter pulmonary valve replacement was used as a non-surgical, less invasive alternative treatment for right ventricular outflow tract dysfunction and has been rapidly developing over the past years. Despite the current favorable results of transcatheter pulmonary valve replacement, many patients eligible for pulmonary valve replacement are still not candidates for transcatheter pulmonary valve replacement. Therefore, one of the significant future challenges is to expand transcatheter pulmonary valve replacement to a broader patient population. This review describes the limitations and problems of existing techniques and focuses on decellularized tissue engineering for pulmonary valve stenting.

Crossroads of parental decision making: Intersections of hope, communication, relationships, and emotions

Parents of children born with complex life-threatening chronic conditions (CLTCs) experience an uncertain trajectory that requires critical decision making. Along this trajectory, hope plays an influential but largely unexplored role; therefore, this qualitative descriptive study explores how parent and provider hope may influence decision making and care of a child born with CLTCs. A total of 193 interviews from 46 individuals (parents, nurses, physicians, and nurse practitioners) responsible for the care of 11 infants with complex congenital heart disease (CCHD) were analyzed to understand how hope features in experiences related to communication, relationships, and emotions that influence decision making. Overall, parental hope remained strong and played a pivotal role in parental decision making. Parents and professional healthcare providers expressed a range of emotions that appeared to be integrally linked to hope and affected decision making. Providers and parents brought their own judgments, perceptions, and measure of hope to relationships, when there was common ground for expressing, and having, hope, shared decision making was more productive and they developed more effective relationships and communication. Relationships between parents and providers were particularly influenced by and contributory to hope. Communication between parents and providers was also responsible for and responsive to hope.

An Unusual Coronary Artery Complication after Surgery for a Complex Congenital Heart Disease: A Case Report

Background: Unexpected events in cardiac surgery may increase morbidity and mortality, which may be more complicated and difficult to manage especially in redo complex congenital heart surgery in children. This report presents a case of unusual coronary artery complication after redo surgery for a complex congenital heart disease. Case Presentation: A female baby with ventricular septal defect, transposition of great arteries and coarctation of the aorta, underwent coarctation repair and pulmonary banding in neonatal period then at one year old, she underwent arterial switch operation and ventricular septal defect repair. In the pediatric cardiac intensive care unit, she required high doses of vasoactive inotropic drugs and echocardiography revealed sever right ventricular dysfunction without significant gradients or shunts. Accordingly, a diagnostic cardiac catheterization was performed and the aortic angiography revealed that the right coronary artery was not inadvertently transferred into the neo -aortic root during the step of arterial switch operation. The surgeon declared that he came upon confounding factors during the intraoperative assessment, which led him to identify a single coronary artery. Immediate reoperation performed to translocate the non-transferred right coronary artery into the neo aortic root and postoperatively the case required extracorporeal membrane oxygenation till she stabilized, and she was discharged in an acceptable condition. Conclusion: Early diagnosis and management of any complications related to coronary artery during pediatric cardiac surgery could lower risk and achieve favorable outcome.

Complications of Surgical Treatment of Aortic Arch Hypoplasia in Infants

Aortic arch surgery in neonatal patients remains problematic despite the constant evolution and improvement of treatment methods. Even after successful correction, complications associated with aortic arch reconstruction are more common in young children. This is especially true for newborns and infants with concomitant complex congenital intracardiac abnormalities. Despite the risk of postoperative complications, the risk of surgical treatment of aortic arch hypoplasia is lower than the cumulative hazards associated with the natural course of this defect. That is why pediatric cardiologists are obliged to constantly monitor the operated patients in order to timely identify and treat complications. The aim. To analyze the complications in the early and remote postoperative periods after the reconstruction of the aortic arch in the neonatal period. Materials and methods. The work is based on a study of 445 patients under 1 year of age, who underwent surgical treatment of aortic arch hypoplasia from 2010 to 2019. The criterion for inclusion in the study group was the presence of isolated hypoplasia of the aortic arch and combination with other defects, which were corrected by two-ventricular repair. The majority of the treated patients were male (284 [63.8% of the total number of patients]). The median age of the patients was 0.7 months (0.3; 2.7). The median body weight of the patients was 3.7 kg (3.25; 4.59). Results. At the hospital stage, 12 patients died, which accounted for 3.1% of the entire cohort of operated patients. Complications occurring at the hospital stage were recorded in 75 (16.8%) patients. In the long term, a complicated course was observed in 72 (16.6%) children. Among them, the most frequent complications were: respiratory failure requiring prolonged mechanical ventilation (36.9%), dilated sternum due to severe heart failure (17.4%), diaphragmatic paresis (8.7%), chylothorax (5.4%). In the long term, 47 (10.5%) patients developed aortic arch restenosis, which required reinterventions. The proportion of patients without reoperations in the follow-up period according to the KaplanMeier analysis was 93.4% after 1 year, 91.2% after 4 years, and 76.5% after 9 years. Residual hypertension requiring medical treatment was reported in 59 (13.2%) patients. Conclusions. Aortic arch hypoplasia is a complex congenital heart disease; its surgical treatment is accompanied by the development of complications both in the early and in the long-term period. The main complications at the hospital stage were respiratory and heart failures which were associated with the presence and correction of concomitant congenital heart defects. The main complication of the follow-up period was reobstruction at the level of the aortic arch. Anatomical correction of reobstruction is safe with both endovascular and surgical treatments.

Long-Term Outcomes After Melody Transcatheter Pulmonary Valve Replacement in the US Investigational Device Exemption Trial

Background: The Melody valve was developed to extend the useful life of previously implanted right ventricular outflow tract (RVOT) conduits or bioprosthetic pulmonary valves, while preserving RV function and reducing the lifetime burden of surgery for patients with complex congenital heart disease. Methods: Enrollment for the US Investigational Device Exemption study of the Melody valve began in 2007. Extended follow-up was completed in 2020. The primary outcome was freedom from transcatheter pulmonary valve (TPV) dysfunction (freedom from reoperation, reintervention, moderate or severe pulmonary regurgitation, and/or mean RVOT gradient >40 mm Hg). Secondary end points included stent fracture, catheter reintervention, surgical conduit replacement, and death. Results: One hundred seventy-one subjects with RVOT conduit or bioprosthetic pulmonary valve dysfunction were enrolled. One hundred fifty underwent Melody TPV replacement. Median age was 19 years (Q1–Q3: 15–26). Median discharge mean RVOT Doppler gradient was 17 mm Hg (Q1–Q3: 12–22). The 149 patients implanted >24 hours were followed for a median of 8.4 years (Q1–Q3: 5.4–10.1). At 10 years, estimated freedom from mortality was 90%, from reoperation 79%, and from any reintervention 60%. Ten-year freedom from TPV dysfunction was 53% and was significantly shorter in children than in adults. Estimated freedom from TPV-related endocarditis was 81% at 10 years (95% CI, 69%–89%), with an annualized rate of 2.0% per patient-year. Conclusions: Ten-year outcomes from the Melody Investigational Device Exemption trial affirm the benefits of Melody TPV replacement in the lifetime management of patients with RVOT conduits and bioprosthetic pulmonary valves by providing sustained symptomatic and hemodynamic improvement in the majority of patients. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00740870.

Mental sequelae of the Covid-19 pandemic: Well-being one year into the crisis in children with and without complex medical histories and their parents

ObjectivesTo understand the long-term mental sequelae for families over the course of the COVID-19 pandemic, the well-being of children with and without complex medical histories and their parents was investigated longitudinally.MethodsWell-being of 200 school-aged children (73 typically-developing, 46 born very preterm, 73 with complex congenital heart disease) and 175 of their parents was assessed prior to and during the first (April–May 2020), second (October–November 2020), and third waves (April–May 2021) of the pandemic with standardized questionnaires. Social and COVID-19-specific determinants were investigated as predictors of impaired well-being.ResultsChild proxy-reported well-being was lower than before the pandemic during the first (P<0.001) and third waves (P=0.01) but not the second (P=0.13). Child self-reported well-being was not lower during the pandemic (all P>0.10). Parent well-being dropped during the first wave (P<0.001) and remained low during the first year (P<0.01). One year into the pandemic, 18/25% of children (self-/proxy-report) and 27% of parents scored below the normal range compared to 11%/10%, and 16%, respectively, before the pandemic. Parents of typically-developing children reported lower well-being than parents of children born very preterm (P=0.006) or with a complex congenital heart disease (P=0.03). Child and parent well-being was lower in families with sparse social support (P<0.001) and poor family functioning (P<0.01).ConclusionThe pandemic continues to impact family well-being one year after its outbreak. Families with sparse social support and poor family functioning are particularly at risk for compromised well-being and support should be provided to them.

Trends in length of stay for Neonatal Intensive Care Unit patients who die before hospital discharge

Objectives: To establish days between birth and death for neonates over a 14-year period, to determine if days between birth and death has changed over time across gestational age (GA) cohorts, and identify diagnoses which may put infants at high risk of prolonged hospitalization leading to death. Study Design: This was a single-site, retrospective chart review of inborn infants who died prior to hospital discharge. Results: 239 patients born between 1/1/2006 and 12/31/2020 met inclusion criteria. Days until death ranged from 0-300 with a median of 6 days (IQR= 23). Median days until death increased over time, with a statistically significant increase between epoch 1 and epoch 2 (p = 0.016) but not between epoch 2 and epoch 3 (p = 0.618). Extremely premature infants died earlier than more mature infants (p < 0.001). In addition, infants who died as a result of complex congenital heart disease or a gastrointestinal (GI) catastrophe died later (p < 0.001 and p < 0.001, respectively) than newborns without cardiac or GI issues. Conclusions: Our findings demonstrate an increase in time to death for newborns who did not survive to hospital discharge over a 14-year period. This trend suggests that the dynamics informing Meadows’ assertion that ‘doomed infants die early’ may be shifting, with some seriously ill infants who die before hospital discharge surviving longer than previously described. More research is needed to understand how best to care for babies who will not survive to discharge and to explore when supports such as palliative care consultation may be beneficial.

Novel use of a mechanical suction thrombectomy system for interposition graft occlusion in complex congenital heart disease

Complete thrombosis of a pulmonary artery interposition graft in an adolescent with complex repaired CHD was treated successfully with a combination of a novel mechanical thrombectomy system, stent implantation, and thrombolysis. This thrombectomy system used a flexible catheter with a built-in mechanism to attenuate blood loss, while providing effective recanalisation of a foreign graft.