Prospective Evaluation of Extubation Failure in Neonates and Infants After Cardiac Surgery.

Background: Extubation failure and its associated complications are not uncommon after pediatric cardiac surgery, especially in neonates and young infants. We aimed to identify the frequency, etiologies, and clinical characteristics associated with extubation failure after cardiac surgery in neonates and young infants. Methods: We conducted a single center prospective observational study of patients ≤180 days undergoing cardiac surgery between June 2022 and May 2023 with at least one extubation attempt. Patients who failed extubation, defined as reintubation within 72 h of first extubation attempt, were compared with patients extubated successfully using χ2, Fisher exact, or Wilcoxon rank-sum tests as appropriate. Results: We prospectively enrolled 132 patients who met inclusion criteria, of which 11 (8.3%) failed extubation. Median time to reintubation was 25.5 h (range 0.4-55.8). Extubation failures occurring within 12 h (n = 4) were attributed to upper airway obstruction or apnea, whereas extubation failures occurring between 12 and 72 h (n = 7) were more likely to be due to intrinsic lung disease or cardiac dysfunction. Underlying genetic anomalies, greater weight relative to baseline at extubation, or receiving positive end expiratory pressure (PEEP) > 5 cmH2O at extubation were significantly associated with extubation failure. Conclusions: In this study of neonates and young infants recovering from cardiac surgery, etiologies of early versus later extubation failure involved different pathophysiology. We also identified weight relative to baseline and PEEP at extubation as possible modifiable targets for future investigations of extubation failure in this patient population.

Twenty-Seven-Year Institutional Experience With Surgery for Adults With Congenital Heart Disease.

BACKGROUND: Given improved contemporary survival of adults with congenital heart disease (ACHD), we aimed to evaluate trends in ACHD surgery and outcomes at a single center over a 27-year period. METHODS: Surgical databases were retrospectively queried for patients >18 years old who underwent ACHD surgery between January 1, 1994, and December 31, 2020. A total of 2,195 included patients underwent 2,425 cardiac surgical procedures within the specified time frame. Patients were grouped by era: I, 1994-2000; 2, 2001-2010; and 3, 2011-2020. Trends in primary cardiac diagnosis and surgical management were evaluated. RESULTS: The median age increased across the eras. The most common primary cardiac diagnoses (n = 2,425) overall were left ventricular outflow tract anomalies (n = 2,019, 83%), atrial septal defect (n = 407, 17%), right ventricular outflow tract anomalies (n = 360, 15%), and ventricular septal defect (n = 110, 4.5%). The most commonly observed procedures overall were operations on the left ventricular outflow tract (n = 1,633, 67%), aorta (n = 675, 28%), coronary arteries (n = 449, 19%), right ventricular outflow tract (n = 323, 13%), and atrial septal defect (n = 264, 11%). Major complications occurred in 10% of cases, and 58 patients died within 30 days of their operation yielding an operative mortality of 2.4%. CONCLUSION: To our knowledge, this is the largest single center report on surgery for adults with congenital heart disease. Surgery for ACHD has been performed at our center with relatively low morbidity and mortality over the last few decades.

Right thoracotomy with central cannulation for valve surgery: 10 years of experience.

BACKGROUND: The aim of this study is to report the early outcomes of valvular heart surgeries performed via the right thoracotomy approach. While thoracotomy with femoro-femoral bypass is an established method for minimally invasive open-heart surgeries, thoracotomy with conventional cannulation is still being explored. In our center, we conducted 958 valvular heart surgery cases using the right anterolateral thoracotomy approach with central cannulation and data were analyzed. METHODS: This is a retrospective observational study based on prospectively collected data from patients who underwent valvular heart surgery at our center spanning from April 2013 to April 2023. The data encompass demographics, procedures, operative techniques, post-operative morbidity, mortality, and a 1-month follow-up. RESULTS: Our study revealed no procedure-related mortality. No patient required conversion to median sternotomy. Smooth cannulation and satisfactory exposure were achieved in all patients. The study encompassed a wide age range, from 14 to 68 years, with 618 female patients (64.5%) and 340 male patients (35.5%). The average cross-clamp time ranged from 38 to 90 min, the duration of cardio-pulmonary bypass ranged from 45 to 105 min, post-operative extubation ranged from 3 to 8 h, the average drain volume ranged from 100 to 350 ml, and the incision size ranged from 5 to 7 cm. CONCLUSIONS: Our data demonstrate that conventional cannulation via the right antero-lateral thoracotomy approach for valvular heart disease is a viable alternative to reduce the side effects associated with sternotomy and femoral cannulation. This procedure is safe, reproducible, and provides the same level of treatment quality.

The potential use of game theory in decision-making in CHD.

Background: Congenital cardiac care involves multiple stakeholders including patients and their families, surgeons, cardiologists, anaesthetists, the wider multidisciplinary team, healthcare providers, and manufacturers, all of whom are involved in the decision-making process to some degree. Game theory utilises human behaviour to address the dynamics involved in a decision and what the best payoff is depending on the decision of other players. Aim: By presenting these interactions as a strategic game, this paper aims to provide a descriptive analysis on the utility and effectiveness of game theory in optimising decision-making in congenital cardiac care. Methodology: The comprehensive literature was searched to identify papers on game theory, and its application within surgery. Results: The analysis demonstrated that by utilising game theories, decision-making can be more aligned with patient-centric approaches, potentially improving clinical outcomes. Conclusion: Game theory is a useful tool for improving decision-making and may pave the way for more efficient and improved patient-centric approaches.

Enhancing cardiac postoperative care: a smartwatch-integrated remote telemonitoring platform for health screening with ECG analysis.

Aims: The integration of smartwatches into postoperative cardiac care transforms patient monitoring, systematically tracking vital signs and delivering real-time data to a centralized platform. This study focuses on developing a platform for seamless integration, assessing reliability, and evaluating the impact on post-cardiac surgery. The goal is to establish a robust foundation for understanding the efficacy and dependability of smartwatch-based telemonitoring, enhancing care for this population. Methods and results: A total of 108 cardiac surgery patients were divided into telemonitoring (TLM) and control (CTL) groups. The TLM group utilized smartwatches for continuous monitoring of vital parameters (SpO2, HR, BP, ECG) over 30 ± 3 days. Statistical analyses (Pearson, Intraclass Correlation, Bland-Altman, Tost Test) were employed to compare smartwatch measurements with traditional methods. Significant correlations and concordance were observed, particularly in HR and BP measurements. Challenges were noted in SpO2 measurement. The ECG algorithm exhibited substantial agreement with cardiologists (Kappa: 0.794; p > 0.001), highlighting its reliability. The telemonitoring platform played a crucial role in early detection of clinical changes, including prompt Emergency Department (ED) visits, contributing significantly to preventing outcomes that could lead to mortality, such as asymptomatic Atrioventricular block. Positive patient responses affirmed technological efficacy, especially in identifying cardiac arrhythmias like atrial fibrillation. Conclusion: The integration of smartwatches into remote telemonitoring for postoperative cardiac care demonstrates substantial potential, improving monitoring and early complication detection, thereby enhancing patient outcomes. The FAPO-X Study (Assisted Digital Telemonitoring with Wearables in Patients After Cardiovascular Surgery; NCT05966857) underscores the promising role of telemonitoring in postoperative cardiac care.

Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery-A review of 148 cases.

BACKGROUND: Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap. METHODS: A single-center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition, n = 116) and Group B (requiring preoperative intravenous inotropic therapy, n = 32). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected. RESULTS: Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post-cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between-group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5 h) and ICU stay (22 vs. 14 days). In-hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long-term survival analysis revealed a significant advantage for Group A. CONCLUSION: The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups. TRIAL REGISTRATION: Local ethics committee, Medical Faculty, Justus-Liebig-University-Giessen (Trial Code Number: 216/14).

Predicting mortality of elderly patients undergoing open heart surgery with delirium using sequential organ failure assessment (SOFA), multi-organ dysfunction (MODS), and logistic organ dysfunction system (LODS) scores.

PURPOSE: This study aims to assess the predictive accuracy of SOFA, MODS, and LODS scores in determining the mortality of elderly undergoing open heart surgery with delirium. METHODS: A prospective study involved 111 elderly patients who met the inclusion criteria. Data were collected using scoring systems: SOFA, MODS, and LODS. RESULTS: Upon final follow-up, 86.5 % of the patients had recovered, 13.5 % had died. Sensitivity, specificity, negative, and positive predictive values for predicting mortality in elderly patients were calculated for the SOFA score as 99 %, 73 %, 98 %, and 76 %, respectively. For the MODS score, these values were 95 %, 60 %, 95 %, and 67 %; for the LODS score, they were 92 %, 73 %, 92 %, and 75 %, respectively. The overall accuracy of the three scores-SOFA, MODS, and LODS-was 84 %, 76 %, and 82 %, respectively. CONCLUSION: The results indicated that the SOFA score exhibited the highest sensitivity and specificity in predicting mortality among elderly individuals.

Highlights of the 18th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion.

The 18th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion was held in Milwaukee, WI, USA, on May 9 and 10, 2024. The conference was hosted by the Herma Heart Institute of Children's Wisconsin at the Pfister Hotel in downtown Milwaukee. This communication provides the highlights of the proceedings.

Impact of Atrioventricular Valve Intervention at Each Stage of Single Ventricle Palliation.

Background: Significant atrioventricular valve dysfunction can be associated with mortality or need for transplant in functionally univentricular heart patients undergoing staged palliation. The purposes of this study are to characterize the impact of concomitant atrioventricular valve intervention on outcomes at each stage of single ventricle palliation and to identify risk factors associated with poor outcomes in these patients. Methods: The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for functionally univentricular heart patients undergoing single ventricle palliation from 2013 through 2022. Separate analyses were performed on cohorts corresponding to each stage of palliation (1: initial palliation; 2: superior cavopulmonary anastomosis; 3: Fontan procedure). Bivariate analysis of demographics, diagnoses, comorbidities, preoperative risk factors, operative characteristics, and outcomes with and without concomitant atrioventricular valve intervention was performed. Multiple logistic regression was used to identify predictors associated with operative mortality or major morbidity. Results: Concomitant atrioventricular valve intervention was associated with an increased risk of operative mortality or major morbidity for each cohort (cohort 1: 62% vs 46%, P < .001; cohort 2: 37% vs 19%, P < .001; cohort 3: 22% vs 14%, P < .001). Black race in cohort 1 (odds ratio [OR] 3.151, 95% CI 1.181-9.649, P = .03) and preterm birth in cohort 2 (OR 1.776, 95% CI 1.049-3.005, P = .032) were notable predictors of worse morbidity or mortality. Conclusions: Concomitant atrioventricular valve intervention is a risk factor for operative mortality or major morbidity at each stage of single ventricle palliation. Several risk factors are associated with these outcomes and may be useful in guiding decision-making.

The Hemodynamic Effects of Bolus Dose Calcium in Patients Undergoing Pulmonary Artery Reconstruction and Unifocalization Surgery: A Pilot Study.

OBJECTIVES: To determine if bolus administration of calcium increases pulmonary artery pressures after unifocalization procedures or pulmonary artery reconstruction surgery. DESIGN: Retrospective cohort study using Stanford University's data warehouse. SETTING: A large pediatric heart center within an academic quaternary care facility. PARTICIPANTS: All patients undergoing pulmonary artery reconstruction or unifocalization procedures identifiable in the data warehouse. INTERVENTIONS: Data were collected from Stanford University's data repository and formatted and analyzed using RStudio (v 2023.06.1+524). MEASUREMENTS AND MAIN RESULTS: The primary outcome was the change in pulmonary artery systolic pressure (PASP) after a bolus administration of calcium. Secondary endpoints include changes in pulmonary arterial-to-systemic arterial pressure ratio, mean arterial pressure, right-sided filling pressure, and left atrial pressure. The Friedman test was used to assess differences and the Durbin-Conover rank-sum for pairwise comparisons. A difference in PASP after a bolus dose of calcium was found (Friedman X2 = 13.67, p = 0.003), with a higher PASP 5 minutes after calcium administration compared with 2 minutes before administration (35 mmHg v 33 mmHg, p = 0.01), and a higher PASP 10 minutes after calcium administration compared with2 minutes before administration (35 mmHg v 33 mmHg, p = 0.008). CONCLUSIONS: Calcium bolus administration led to an increase in pulmonary arterial pressure in patients after pulmonary artery reconstruction or unifocalization surgeries. It may be prudent to avoid bolus administration in this patient population immediately after repair or in patients with right ventricular dysfunction.

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.

Determining the Spiritual Care and Comfort Needs of Patients Having Undergone Open-Heart Surgery: Cross-Sectional Descriptive Study in Turkey.

This study was aimed at determining the spiritual care and comfort needs of patients having undergone open-heart surgery. This cross-sectional descriptive study was conducted with 147 patients in the Cardiovascular Surgery Intensive Care Unit of a training and research hospital in Izmir, a province in western Turkey, between May 1, 2022 and November 1, 2022. The comfort level of the patients who had undergone open-heart surgery was moderate, and the levels of their spiritual care needs were high. A statistically significant relationship was found between the patients' Perianesthesia Comfort Scale total score and the Spiritual Care Needs Inventory (p < 0.05). We concluded that the patients' comfort levels decreased as their spiritual care needs increased. We recommend authors to conduct studies in the future which should include different sample groups and compare the data obtained before and after the surgery.

Efficacy of prescribing Inderal for polymorphic ventricular tachycardia in a young patient with the normal QT interval: A case report study.

Polymorphic ventricular tachycardia (PVT) is a group of life-threatening heart rhythm disorders. These arrhythmias share similar electrocardiographic characteristics but require different modes of therapy for effective treatment. It is important to note that the medications that are considered the first-line treatment for one type of PVT may not be appropriate for another type, and may worsen the condition. Therefore, it is crucial to accurately diagnose the type of PVT before initiating treatment to provide the most effective therapy for the patient. A 42-year-old man was admitted to the emergency department with dyspnea, Levine sign, and severe chest pain. His electrocardiogram showed ST elevation, and the QT interval was normal. The patient was sent to the cath lab based on the treatment protocols. According to the results of angiography, three coronary arteries were severely obstructed. His coronary arteries did not open during percutaneous coronary intervention; thus, the healthcare team decided on open heart surgery. He suffered from recurrent PVT following open heart surgery and did not respond to any of the drugs suitable for this type of tachycardia. Inderal prevented the recurrence of ventricular tachycardia (VT) in a patient with polymorphic VT without QT prolongation, contrary to the healthcare team's expectations. Inderal was used as the last line of treatment because this patient's arrhythmia was polymorphic VT without QT prolongation. Inderal is typically used for treating VT in patients with long QT syndromes and heart structural disorders. This case report aims to highlight the impact of Inderal on polymorphic tachycardia, specifically in cases where the QT interval is not elongated. In this particular case, the standard treatment approaches were ineffective in preventing reversibility, but Inderal proved to be successful. Therefore, we feel it is important to document and share this case.

Pulmonary Atresia and Ventricular Septal Defect Without Major Aortopulmonary Collateral Arteries: Diagnostic Evaluation and the Role of Ductal Stenting.

Patients with pulmonary atresia (PA) and a ventricular septal defect (VSD), similar to those with tetralogy of Fallot and PA without major aortopulmonary collateral arteries, lack antegrade pulmonary blood flow, and thus require a neonatal intervention for stabilization or augmentation of pulmonary blood flow. The role of ductal stenting in the management of these patients, and the current literature supporting it, will be reviewed.

On a healing journey together and apart: A Swedish critical incident technique study on family involvement from a patient perspective in relation to elective open-heart surgery.

BACKGROUND: As family members affect patient outcomes following open-heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open-heart surgery in Sweden. METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not. ETHICAL ISSUES AND APPROVAL: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps. RESEARCH METHODS: Individual interviews were conducted with 35 patients who underwent open-heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method. RESULTS: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk-taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support. CONCLUSIONS: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open-heart surgery.

Assessment of Upper Limb Nerves in Coronary Artery Disease Patients Undergoing Coronary Artery Bypass Graft.

Background Many patients experience pain in their upper limbs following surgical procedures involving median sternotomy, particularly those undergoing coronary artery bypass grafting (CABG). This type of pain, commonly reported by CABG patients, is often overlooked in hospital settings. Our study aims to address this issue by utilizing electrodiagnostic studies to understand this postoperative discomfort better. Objectives Cardiovascular procedures are standard and are trending toward endovascular interventions. Through this study, we aim to assess the occurrence of neurological issues in the upper limbs after CABG by comparing patients' preoperative and postoperative electrophysiological studies of the upper limb nerves. Materials and methods A prospective study was performed on 32 coronary artery disease (CAD) patients undergoing CABG to determine the effects of surgery on the upper limb nerves (median and ulnar nerves). We performed nerve conduction studies (NCS) and analyzed different parameters of both median and ulnar nerves pre and post-surgery. Results A change was noted in different NCS parameters of the median and ulnar nerves when we compared the pre and post-surgical values. The mean latency of the median nerve sensory increased from a minimum of 3.01 milliseconds at the preoperative level to a maximum of 3.60 milliseconds when assessed two weeks post-surgery. The mean amplitude decreased from 16.49 microvolts to a minimum of 12.30 microvolts when assessed two weeks post-surgery. The mean velocity decreased from 55.83 m/s at the preoperative value to a minimum of 45.03 m/s at the two weeks post-surgery assessment. The ulnar nerve also underwent similar changes. Conclusion The observed changes in latency, amplitude, and velocity might be attributed to various factors, including surgical trauma, inflammation, or alterations in the physiological state post-surgery. The sternotomy technique and the position and extent of opening the sternal retractor determine the prevalence of complications by causing injury to the medial and lateral cords of the brachial plexus after CABG. Careful preoperative and postoperative assessments of patients may aid in preventing, minimizing, and treating these often undiagnosed complications.

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.

The modified exhaust method is used in open-heart surgery for cardiopulmonary bypass in children with congenital heart disease.

Objective: This study aimed to assess the efficacy of a modified exhaust method in pediatric open-heart surgery involving cardiopulmonary bypass. Method: Data from 303 cases conducted at the Department of Cardiac Surgery, Guizhou Hospital, Shanghai Children's Medical Center, between October 2023 and March 2024 were analyzed. Among these cases, 202 utilized the modified exhaust method, divided into group A (101 cases with median thoracotomy) and group C (101 cases with lateral thoracotomy), while 101 cases used the traditional exhaust method in group B (median thoracotomy). Comparative analysis included general patient data, cardiopulmonary bypass duration, aortic cross-clamp time, time for exhaust and reperfusion upon opening, post-reperfusion ST segment abnormalities on electrocardiogram, intracardiac pneumogram observations via esophageal ultrasound, relevant plasma biochemical indexes on postoperative day one, postoperative drainage volume, duration of ventilator use, and length of stay in the intensive care unit (ICU). Results: There was no difference in between-group comparisons regarding age (27.98 ± 3.57 vs. 34.05 ± 3.96 months; P = 0.401) and weight (12.23 ± 0.55vs. 12.59 ± 0.70 Kg; P = 0.563). Longer Cardiopulmonary bypass times were observed in patients undergoing median thoracotomy than those undergoing lateral thoracotomy (group B: 108.47 ± 2.30 min vs. group C: 117.03 ± 2.82 min, P = 0.002; group A: 108.91 ± 2.63 min vs. group C: 117.03 ± 2.82 min, P = 0.035). Exhaust and rebound times after opening were significantly shorter in the modified exhaust-method group compared with the traditional-method group (Group A: 52.62 ± 1.39 s vs. Group B: 65.20 ± 1.49 s, P < 0.001; Group B: 65.20 ± 1.49 s vs. Group C: 4.31 ± 1.16 s, P < 0.001). There was no statistical difference in terms of postoperative biochemical indexes, drainage volume, ventilator use time, and ICU stay time (all P > 0.05). Conclusions: The modified exhaust method demonstrates overall good immediate results in pediatric congenital heart surgery. It was superior to the traditional exhaust method in terms of reducing exhaust times and potentially minimizing the risk of local aortic injuries. Additionally, it appeared to be suitable for lateral thoracotomy surgery.

Rationale and Design of the Randomized COmparison of Methods for Pulmonary Blood Flow Augmentation: Shunt Versus Stent (COMPASS) Trial: A Pediatric Heart Network Study.

Neonates with congenital heart disease and ductal-dependent pulmonary blood flow (DD-PBF) require early intervention. Historically, this intervention was most often a surgical systemic-to-pulmonary shunt (SPS; eg, Blalock-Thomas-Taussig shunt). However, over the past two decades, an alternative to SPS has emerged in the form of transcatheter ductal artery stenting (DAS). While many reports have indicated safety and durability of the DAS approach, few studies compare outcomes between DAS and SPS. The reports that do exist are comprised primarily of small-cohort single-center reviews. Two multicenter retrospective studies suggest that DAS is associated with similar or superior survival compared with SPS. These studies offer the best evidence to-date, and yet both have important limitations. The authors describe herein the rationale and design of the COMPASS (COmparison of Methods for Pulmonary blood flow Augmentation: Shunt vs Stent [COMPASS]) Trial (NCT05268094, IDE G210212). The COMPASS Trial aims to randomize 236 neonates with DD-PBF to either DAS or SPS across approximately 27 pediatric centers in North America. The goal of this trial is to compare important clinical outcomes between DAS and SPS over the first year of life in a cohort of neonates balanced by randomization in order to assess whether one method of palliation demonstrates therapeutic superiority.

Factors predicting depression among persons post-coronary artery bypass graft surgery: A cross-sectional study in Thailand.

Background: Coronary artery bypass graft (CABG) surgery is a highly effective coronary artery disease treatment, providing immediate relief and promising long-term benefits. However, it is a major procedure with significant risks, including the potential for depression. Many patients experience depression following CABG, which can negatively impact their overall recovery, affecting both physical and mental health. Objective: This study aimed to determine factors predicting depression in patients following CABG surgery. Methods: This cross-sectional study was conducted with data collected between January and April 2024. A total of 272 post-CABG patients from two super tertiary care hospitals in Bangkok, Thailand, were recruited through purposive sampling. All research instruments were validated and tested for reliability. Data were analyzed using multiple regression analysis. Results: The study found that hope, optimism, illness perception, social support, and anxiety were correlated with depression (adjusted R² = 0.381), but these variables explained only 38.1% of the variance (p <0.05). Among these factors, anxiety (ß = 0.311), optimism (ß = 0.203), social support (ß = -0.117), and illness perception (ß = -0.143) were significant predictors (p <0.05), while hope was not a significant predictor. Thus, anxiety emerged as the most crucial predictor of depression in patients who have undergone CABG. Conclusion: Nurses play a vital role in preventing and managing depression in post-CABG patients. Screening for anxiety and addressing it can prevent depression, enhance social support, and improve outcomes. To develop effective nursing strategies, it is essential for nurses to assess anxiety and implement interventions that promote social support, optimism, and illness perception. These measures can improve care quality, reduce readmission rates, and enhance patients' overall quality of life.