Tricuspid mechanical valve replacement for severe tricuspid stenosis in a child who underwent surgical correction of complete atrioventricular septal defect, a rare long-term complications.

BACKGROUND: Complete atrioventricular septal defect is a complicated congenital heart malformations, and surgical correction is the best treatment, the severe tricuspid stenosis is a rare long-term complication after the surgery. CASE PRESENTATION: We report a case with the complication of severe tricuspid stenosis 7 years after the surgical correction of complete atrioventricular septal defect in a child. Then the patient underwent tricuspid mechanical valve replacement, Glenn, atrial septostomy, and circumconstriction of the right pulmonary artery. CONCLUSIONS: The patient recovered successfully with good short-term.

The Association Between Religious Belief and Postoperative Psychological Status and Quality of Life of Parents of Children with Congenital Heart Disease: A Single Center Experience in Southeast China.

This study aimed to investigate the association of religious belief on the postoperative psychological status and quality of life of parents of children with congenital heart disease (CHD). This was a cross-sectional study conducted at a provincial children's hospital in Fujian Province, China. Parents of postoperative children with CHD in the early postoperative period were included in this study between January 2020 and September 2020. The parents were divided into a religious belief group (n = 39) and a nonreligious belief group (n = 42) depending on whether they had religious beliefs. The Religious Coping Questionnaire, WHOQOL-BREF scale, Self-rating depression scale (SDS), and Self-rating anxiety scale (SAS) were used to evaluate psychological status and quality of life. The results showed that the SDS and SAS scores in the religious belief group were significantly lower than those in the nonreligious belief group (P = 0.012 and P = 0.003, respectively). The WHOQOL-BREF scale results showed that the religious belief group's score was significantly higher than those in the nonreligious belief group on the subscale scores of physiology, psychology, social relations, and environment on the WHOQOL-BREF. The total score of quality of life in the religious belief group was significantly higher than that in the nonreligious belief group. Religious belief was associated with lower SDS score (ß = - 0.324, P = 0.005) and SAS score (ß = - 0.245, P = 0.026), while religious belief was positively correlated with the score of WHOQOL-BREF (ß = 0.506, P < 0.001). In this study, we concluded that comparing to those with no religious beliefs, parents with religious belief experienced more positive emotions and higher quality of life when taking care of children in the early postoperative period after congenital heart surgery.

Using WeChat to guide preparation before transthoracic echocardiography reduces anxiety and improves satisfaction of parents of infants with congenital heart disease.

OBJECTIVE: To explore the effect of using WeChat to guide preparation before transthoracic echocardiography (TTE) on reducing anxiety and improving the satisfaction of parents of infants with congenital heart disease (CHD). METHODS: This study was a retrospective study conducted in a children's hospital. The clinical data of 44 patients and the anxiety and satisfaction data of their parents who received WeChat guidance were collected between December 2021 and January 2022 (the WeChat group). The corresponding data of 47 patients and their parents who received educational brochure guidance were collected between September 2021 and November 2021 (the routine group). Guidance was used to help the parents prepare for TTE performed by medical professionals. The State-Trait Anxiety Inventory scale and the Patient Satisfaction Questionnaire-18 (PSQ-18) were used. The data of the two groups were compared and analyzed. RESULTS: The comparison of parental anxiety between the two groups showed that the scores of state anxiety and trait anxiety in the WeChat group were significantly lower than those in the routine group (p < 0.05). The comparison of the results of the PSQ-18 showed that the scores for general satisfaction, interpersonal manner, communication, time spent with the physician, and accessibility and convenience in the WeChat group were significantly higher than those in the routine group (p < 0.05). CONCLUSION: Using WeChat to guide preparation before TTE for infants with CHD can effectively reduce the anxiety of their parents and improve their parents' satisfaction with medical treatment.

Parents' understanding and attitudes toward the use of the WeChat platform for postoperative follow-up management of children with congenital heart disease.

OBJECTIVE: This study aimed to investigate parents' understanding and attitudes toward using the WeChat platform for postoperative follow-up management of children with congenital heart disease (CHD). METHODS: A total of 196 children with CHD were followed up using the WeChat platform. A self-designed questionnaire was administered to their parents at discharge. RESULTS: Only 188 parents completed the questionnaire. One hundred nineteen parents (63.3%) confirmed that they heard about using the WeChat platform for postoperative follow-up, and 104 (87.4%) of them expressed that they were willing to accept the WeChat platform for their follow-up. A total of 42 parents (35.3%) were willing to undergo a follow-up of 1 to 3 months, and 32 (26.8%) were willing to undergo a long-term follow-up. Eighty parents (67.2%) had a positive attitude toward the effect of the WeChat platform on follow-up. Parents in rural areas and those educated at the middle school level or below were more willing to engage with the WeChat platform for postoperative follow-up management (P < 0.05). CONCLUSIONS: Although the WeChat platform is an essential tool for daily communication, its application in postoperative follow-up management is still under study. Most parents who participated in the follow-up study had a positive attitude toward the WeChat platform, especially those in rural areas and with lower education levels.

Postoperative health-related quality of life in children with congenital heart disease: a short-term follow-up study.

OBJECTIVE: This study aimed to explore changes in health-related quality of life in children with congenital heart disease from pre-surgery to 6 months after surgery. METHODS: A total of 87 children aged 2-12 years who underwent cardiac surgery in a provincial hospital in China from January 2021 to June 2021 were selected. After 6 months, the quality of life of all children was retrospectively analyzed. The Chinese version of the Pediatric Quality of Life Inventory 4.0 Scale was used to assess the quality of life of children before and after surgery. RESULTS: Parents of 85 children and 33 children aged 5-12 years completed the questionnaires. After surgical treatment, the quality of life scores reported by parents of children of all ages were significantly higher than those before surgery, the P value < 0.05; the self-evaluated quality of life scores of children of different ages were significantly higher than those before surgery, the P value < 0.05. CONCLUSION: Surgical treatment can improve the health-related quality of life of children with congenital heart disease.

The effect of applying telehealth education to home care of infants after congenital heart disease surgery.

BACKGROUND: The purpose of this study was to investigate the effect of applying telehealth education to home care of infants after congenital heart disease (CHD) surgery. METHODS: A prospective randomized controlled study was conducted from July 2020 to February 2021 in Fujian Children's Hospital to compare the home care condition of infants after CHD surgery between the intervention group and the control group. RESULTS: At 3 months after discharge, parents' caring ability and CHD knowledge in the intervention group were significantly better than those in the control group and were significantly improved compared with those at discharge time (P < 0.05). The parental care burden in the intervention group was significantly lower than that in the control group and was significantly lower than that at discharge time (P < 0.05). During the follow-up period, the rate of loss of follow-up and complications in the intervention group were significantly lower than those in the control group (P < 0.05). CONCLUSION: Telehealth education via WeChat can effectively improve the knowledge of disease and home care ability of parents of infants after CHD surgery and reduce their home care burden, which can effectively reduce the incidence of complications and lost to follow-up rate after discharge.

Rescue high-frequency oscillatory ventilation combined with intermittent mandatory ventilation for infants with acute respiratory distress syndrome after congenital heart surgery.

BACKGROUND: This study aimed to evaluate the efficacy and safety of high-frequency oscillation ventilation combined with intermittent mandatory ventilation in infants with acute respiratory distress syndrome after congenital heart surgery. METHODS: We retrospectively analysed the clinical data of 32 infants who were ventilated due to acute respiratory distress syndrome after congenital heart surgery between January, 2020 and January, 2022. We adopted high-frequency oscillation ventilation combined with intermittent mandatory ventilation as the rescue ventilation mode for infants who were failing conventional mechanical ventilation. RESULTS: After rescue high-frequency oscillation ventilation combined with intermittent mandatory ventilation, the dynamic compliance (Cdyn), PaO2 and PaO2/FiO2 ratio of the infants improved compared with conventional mechanical ventilation (p < 0.05). Moreover, high-frequency oscillation ventilation combined with intermittent mandatory ventilation resulted in a significant decrease in arterial-alveolar oxygen difference (AaDO2), FiO2, and oxygenation index (p < 0.05). No significant effect on haemodynamic parameters was observed. Moreover, no serious complications occurred in the two groups. CONCLUSION: Rescue high-frequency oscillation ventilation combined with intermittent mandatory ventilation significantly improved oxygenation in infants who failed conventional mechanical ventilation for acute respiratory distress syndrome after congenital heart surgery. Thus, this strategy is considered safe and feasible. However, further studies must be conducted to confirm the efficacy and safety of high-frequency oscillation ventilation combined with intermittent mandatory ventilation as a rescue perioperative respiratory support strategy for CHD.

Short-Term Nutritional Support Improves The Preoperative Nutritional Status of Infants With Non-Restrictive Ventricular Septal Defect: A Prospective Controlled Study.

OBJECTIVE: To investigate the effect of short-term nutritional support on improving preoperative nutritional status of infants with non-restrictive ventricular septal defect. METHODS: A prospective randomized controlled study was conducted from June 2021 to December 2021 at a provincial children's hospital in China. The difference of nutritional status between the intervention group and the control group after short-term nutritional support was compared. RESULTS: After one month of nutritional support, the weight, STRONGkids score, albumin, prealbumin, and hemoglobin in the intervention group significantly were higher than those in the control group (P < 0.05). The postoperative intensive care time and discharge time of the two groups significantly were lower in the intervention group than those in the control group (P < 0.05). CONCLUSION: The preoperative nutritional support of 1 month for infants with non-restrictive ventricular septal defect can effectively improve their preoperative nutritional status and promote postoperative recovery.

Application of High-Frequency Oscillation Ventilation Combined With Volume Guarantee in Preterm Infants With Acute Hypoxic Respiratory Failure After Patent Ductus Arteriosus Ligation.

OBJECTIVE: This study aimed to evaluate the efficacy and safety of high-frequency oscillation ventilation combined with volume guarantee (HFOV-VG) in preterm infants with acute hypoxemic respiratory failure (AHRF) after patent ductus arteriosus ligation. METHODS: We retrospectively analyzed the clinical data of 41 preterm infants, who were ventilated for AHRF after patent ductus arteriosus ligation between January 2020 and January 2022. HFOV alone was used in 20 of the 41 infants, whereas HFOV-VG was used in the other 21 infants. RESULTS: There was no statistically significant difference in the demographic information and baseline characteristics of preterm infants included in the study. The average frequency tidal volume (VThf) of the HFOV-VG group was lower than that of the HFOV group (2.6 ± 0.6 mL versus 1.9 ± 0.3 mL, P < .001). In addition, the incidence of hypocapnia and hypercapnia in infants supported with HFOV-VG was significantly lower (15 versus 8, P < .001; 12 versus 5, P < .001). Furthermore, the duration of invasive ventilation in the HFOV-VG group also was lower than in the HFOV group (3.7 ± 1.2 days versus 2.1 ± 1.0 days, P < .01). CONCLUSION: Compared with HFOV alone, HFOV-VG decreases VThf levels and reduces the incidence of hypercapnia and hypocapnia in preterm infants with acute hypoxic respiratory failure after patent ductus arteriosus ligation.

The effect of short music videos on needs satisfaction and separation anxiety of children's family members during COVID-19: The example of TikTok.

Objective: To investigate the effect of short music videos on needs satisfaction and separation anxiety of the family members of children with congenital heart disease (CHD) in the cardiac intensive care unit (CICU) during the COVID-19 pandemic. Methods: Eighty-seven children's family members were divided into the study group and the control group between February 2020 and March 2021. During the COVID-19 pandemic, the participants in the control group were visited by telephone, while the participants in the study group used the TikTok short music video application and WeChat as communication tools. After the intervention, the critical care family needs inventory (CCFNI) and separation anxiety scale (SAS) for all participants were recorded and analyzed. Results: There were no statistically significant differences in general characteristics or preintervention data between the two groups. However, the two dimensions of the support scale and information scale of the CCFNI in the study group were significantly different from those in the control group after the intervention (P = 0.008, and P = 0.021, respectively). There were significant differences in the three dimensions of the SAS between the two groups (P = 0.004, P = 0.007, and P = 0.041, respectively). Conclusion: The visiting system of the ICU changed during the COVID-19 pandemic, and the use of the TikTok short music video application and WeChat was conducive to optimizing the CICU ward visiting process, reducing the separation anxiety of the family members of children in the CICU, and improving their needs satisfaction.

Application of metagenomic next-generation sequencing in the detection of pathogens in bronchoalveolar lavage fluid of infants with severe pneumonia after congenital heart surgery.

Background: Metagenomic next-generation sequencing (mNGS) has become a valuable diagnostic tool in clinical etiology detection due to its rapidity, accuracy, and high throughput. However, the role of this technology in the diagnosis and treatment of infants with severe pneumonia after congenital heart surgery is still unclear. Methods: We conducted a retrospective cohort study of infants with severe pneumonia after congenital heart surgery. Samples were collected from infants in the hospital's cardiac intensive care unit between January 2010 and January 2022. The conventional microbiological test (CMT) group consisted of patients who underwent routine microbiological examination, and the infants' bronchoalveolar lavage fluid was examined. The mNGS group consisted of patients who underwent mNGS and routine microbiological examinations. Results: The overall positive rate of mNGS was significantly higher than that of CMT (88.4 vs. 62.5%, P = 0.009). After receipt of the microbiological results, 30/43 (70%) patients in the mNGS group had a change in antibiotic use compared with 14/40 (35%) in the CMT group (P = 0.002). Subsequently, after adjusting the treatment plan according to the microbiological test results, the number of people with improved pulmonary infection in the mNGS group was significantly higher than that in the CMT group (63 vs. 28%, P < 0.05). In addition, the duration of invasive ventilation, length of CICU stay and total hospital length of stay in the mNGS group were significantly lower than those in the CMT group (P < 0.05). Conclusion: mNGS is a valuable tool to determine the etiology of infants with severe pneumonia after congenital heart disease surgery. It can significantly improve the sensitivity of pathogen detection, which can help determine appropriate antimicrobial drugs, improve the diagnostic accuracy of the disease, and improve outcomes.

Using Telemedicine Strategy to Implementing Nutrition Management for Neonates After Congenital Heart Disease Surgery: A New Nutrition Management Strategy.

Objective: The purpose of this study was to investigate the effect of remote nutrition management on promoting the growth and development of neonates after congenital heart disease (CHD) surgery. Materials and Methods: This study retrospectively analyzed the clinical data of 32 neonates after CHD surgery who received remote nutrition management from January 2021 to July 2021 in our hospital. The clinical data of 30 neonates after CHD surgery, who did not receive remote nutrition management from June 2020 to December 2020, was used as control. The growth and development of the two groups were compared. Results: Three months after discharge, the weight, height, and weight-for-age z score (WAZ) of the intervention group was significantly higher than those of the control group. The amount of milk in the intervention group was also significantly more than that of the control group, and more neonates in the intervention group added high-energy milk or breast milk fortifier than the intervention group. The parental care ability of the intervention group was significantly higher than that of the control group. The incidence of respiratory tract infection and readmission in the intervention group was significantly lower than that in the control group. Conclusion: As a new nutrition management strategy for neonates after CHD surgery, remote nutrition management can effectively improve the nutritional status of neonates and promote their growth and development.

The Interventricular Septal Hematoma Following Surgical Correction of Ventricular Septal Defect in Infants: A Single-Center Experience.

OBJECTIVE: To review and analyze the cases of interventricular septal hematoma (IVSH) following surgical correction of the ventricular septal defect (VSD) in infants in our center. METHODS: Retrospective analysis was performed on five infants with IVSH after surgical correction of VSD in our center from January 2020 to January 2022. The general preoperative information and intraoperative and postoperative results were collected and analyzed. RESULTS: All five infants with VSD were repaired under cardiopulmonary bypass and occurred IVSH. The cardiac arrest occurred in one patient five hours after return to the intensive care unit (ICU). The patient's hemodynamics were difficult to maintain after cardiopulmonary resuscitation, and the patient died. Two other patients had arrhythmia and unstable hemodynamics during the perioperative period, the hematoma puncture was performed, and the patients' symptoms lessened. Perioperative and postoperative echocardiography showed that the hematoma gradually was shrunk, and the hemodynamics became stable. The hemodynamics were stable in the remaining two infants during the perioperative period. No specific medical intervention was required other than clinical observation in these two patients. Finally, the four infants successfully were discharged with good clinical results. CONCLUSION: IVSH is a rare complication of surgical repair of VSD. Prevention and early detection of IVSH during operation in infants with VSD are essential.

Subepicardial lipoma of the posterior atrioventricular sulcus in children: a case report and review of the literature.

Cardiac lipoma is rarely reported in the pediatric population. We reported a case of subepicardial lipoma of the posterior atrioventricular sulcus in a child. The tumor was resected successfully and the patient recovered well after the operation.

Effect of High-Frequency Oscillatory Ventilation, Combined With Prone Positioning, in Infants With Acute Respiratory Distress Syndrome After Congenital Heart Surgery: A Prospective Randomized Controlled Trial.

OBJECTIVES: This study aimed to evaluate the effect of high-frequency oscillatory ventilation, (HFOV) combined with prone positioning, on oxygenation and pulmonary ventilation in infants with acute respiratory distress syndrome (ARDS) after congenital heart surgery. DESIGN: A randomized controlled trial. SETTING: A single-center study at a tertiary teaching hospital. PARTICIPANTS: Patients with postoperative ARDS after congenital heart disease were divided randomly into the following 2 groups: HFOV combined with prone position (HFOV-PP), and HFOV combined with supine position (HFOV-SP). INTERVENTIONS: The primary outcomes were the PaO2/FIO2 ratio and the oxygenation index after the intervention, and the secondary outcomes were respiratory variables, hemodynamics, complications, and other short-term outcomes. RESULTS: Sixty-five eligible infants with ARDS were randomized to either the HFOV-PP (n = 32) or HFOV-SP (n = 33) group. No significant difference in baseline data was found between the 2 groups (p > 0.05). Oxygenation was improved in both groups after HFOV intervention. Compared with the HFOV-SP group, the HFOV-PP group had significantly increased PaO2/FIO2 and oxygenation index and a shorter duration of invasive ventilation and length of cardiac intensive care unit stay. No serious complications occurred in the 2 groups. CONCLUSION: HFOV-PP significantly improved oxygenation in infants with ARDS after cardiac surgery and had no serious complications.

Using Human Milk Fortifiers to Improve the Preoperative Nutritional Status of Infants With Non-restricted Ventricular Septal Defect.

Objective: To explore the effects of human milk fortifier (HMF) on improving the preoperative nutritional status of infants with non-restricted ventricular septal defect (VSD). Methods: A prospective randomized controlled study was conducted in a provincial hospital in China. Participants were randomly divided into an intervention group (n = 29) and a control group (n = 29). HMFs were added proportionally to the infants' feeds in the intervention group based on breastfeeding status, and the infants in the control group received exclusive breastfeeding as needed. The nutritional status of the two groups was compared 1 month after the intervention. Results: Compared with the control group, the weight, head circumference, height, albumin level, and prealbumin level of the human milk fortifier group were significantly higher 1 month after the intervention (p < 0.05). The STRONGkids score of the HMF group was significantly lower than that of the non-HMF group (p < 0.05). There was no significant difference in pneumonia, liver insufficiency, feeding intolerance, or jaundice between the two groups. Conclusion: The addition of HMFs based on the breastfeeding status of infants with non-restricted VSD can improve the preoperative nutritional status and does not increase the incidence of gastrointestinal complications. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier: ChiCTR2000041135.

Short-Term Nutritional Support for Infants With Unrestricted Ventricular Septal Defects to Promote Postoperative Recovery.

Objective: This study is aimed to explore the effect of short-term nutritional support for infants with unrestricted ventricular septal defects on improving preoperative nutritional status and promoting postoperative recovery. Methods: The clinical data of 35 infants with unrestricted ventricular septal defects who were treated with 2 weeks of nutritional support in our hospital from December 2020 to March 2021 were analyzed retrospectively. The clinical data of 38 infants with unrestricted ventricular septal defects who were treated in our hospital from May 2020 to October 2020 were selected as controls. Results: The preoperative body weight, preoperative albumin, preoperative prealbumin, and preoperative hemoglobin in the intervention group were significantly higher than those in the control group (P < 0.05). The postoperative ventilator time, intensive care time, and discharge time in the intervention group were significantly shorter than those in the control group (P < 0.05). Conclusion: Performing 2 weeks of nutritional support for infants with unrestricted ventricular septal defects can improve their preoperative nutritional status and promote postoperative recovery.

Bi-level Positive Airway Pressure Versus Nasal CPAP for the Prevention of Extubation Failure in Infants After Cardiac Surgery.

BACKGROUND: Extubation early in the postoperative period is beneficial to the recovery and rehabilitation of patients. This study compared the postoperative extubation failure rates among infants who received postextubation respiratory support by either bi-level positive airway pressure (BPAP) or nasal CPAP following cardiac surgery. METHODS: This was a single-center randomized controlled trial registered at the Chinese Clinical Trial Registry (number ChiCTR2000041453) and was conducted between January 2020 and March 2021. Ventilated infants who underwent cardiac surgery were randomized to either a BPAP or a nasal CPAP group for ventilatory support following extubation. The primary outcome measure was the extubation failure rate within 48 h. RESULTS: The analyses included 186 subjects. Treatment failure necessitating re-intubation was noted in 14 of the 93 infants (15%) in the BPAP group and in 11 of the 93 infants (12%) in the nasal CPAP group (P = .52). Moreover, there were no statistically significant differences between the 2 groups regarding the duration of noninvasive ventilation (P = .54), total enteral feeding time (P = .59), or complications (P = .85). We found that both the BPAP group and the nasal CPAP group showed significantly improved oxygenation and relief of respiratory distress after treatment. However, the PaCO2 level within 24 h was significantly lower in the BPAP group (P = .001) than in the CPAP group. Additionally, the PaO2 /FIO2 in the BPAP group was significantly higher than in the nasal CPAP group at 6 h, 12 h, and 24 h after treatment (P < .001). CONCLUSIONS: The introduction of BPAP for postextubation respiratory support was not inferior to nasal CPAP in infants after cardiac surgery. Moreover, BPAP was shown to be superior to nasal CPAP in improving oxygenation and carbon dioxide clearance.

Influence of percutaneous catheter intervention for congenital perimembranous ventricular septal defects in children on the cardiac conduction system and associated risk factors: a meta-analysis.

BACKGROUND: The aim of this study was to investigate adverse outcomes and risk factors for the cardiac conduction system in children with perimembranous ventricular septal defects (pmVSDs) who had been treated by catheter intervention. METHOD: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies in English on interventional treatment of pmVSDs in pediatric patients published up to the end of October 15, 2020. We used random- or fixed-effect models to obtain pooled estimates of the success rate and postoperative complications. RESULTS: A total of 1650 pediatric patients from 8 publications were included, with a mean age ranging from 3.44 to 8.67 years old. The pooled estimate of successful implantation was 98.2% (95% CI 97.1-99.4%, I2 = 69.4%; P < 0.001), and the incidence of cardiac conduction system complications was 17.4% (95% CI 8.4-26.4%, I2 = 96.1%; P < 0.001), among which the incidence of heart block was 14.8% (95% CI 6.4-23.3%, I2 = 96.9%; P = 0.001). The incidence of impulse formation disorders was 4.1% (95% CI 0.7-7.6%, I2 = 91.7%; P = 0.019), and the incidence of complete atrioventricular block was 0.8% (95% CI 0.3-13%, I2 = 0.0%; P = 0.001). Risk factors for newly emerging arrhythmias included the VSD size MD = 0.89 (95% CI 0.46-1.32, I2 = 0%; P < 0.0001) and device size MD = 1.26 (95% CI 0.78-1.73, I2 = 0%; P < 0.00001). CONCLUSIONS: Percutaneous catheter intervention is safe and effective in treating pediatric patients with pmVSD, and the risk factors leading to arrhythmias include the sizes of the pmVSD and device.

Unplanned Return to Cardiac Intensive Care Unit of Children After Congenital Heart Surgery: Incidence, Outcomes, and Risk Factors.

OBJECTIVE: Factors leading to an unplanned return to the cardiac intensive care unit (CICU) in children after congenital heart disease and their impact on mortality have not been well characterized. We sought to determine the incidence and outcomes of unplanned return to the CICU. A secondary objective was to identify risk factors. METHODS: Retrospective analysis of the registration data collected by our unit. The study subjects included postoperative patients with congenital heart disease who survived to initial transfer out of the CICU. Patients who unexpectedly returned to the CICU due to an acute change in clinical status were defined as unplanned returns. Demographic, preoperative, intraoperative, and postoperative variables were assessed. Univariate comparisons were performed between the return group and non-return group, and multivariate regression analysis was performed to identify potential risk factors for unplanned return to the CICU. RESULTS: Of the 531 children who met the inclusion criteria, 29 were unplanned returns to the CICU. Respiratory symptoms (41.4%) and cardiac symptoms (44.8%) were the most common reasons for returning to the CICU. Patients with unplanned returns had a higher mortality rate (13.8% vs. 0.56%, P < 0.01). In multivariate analysis, unplanned CICU admission was associated with chromosomal abnormalities (P < 0.01), longer ventilator duration (P < 0.01), and more prolonged cardiopulmonary bypass (P < 0.01) was associated with a return to independence. CONCLUSIONS: Unplanned return to the CICU during the same hospital stay was uncommon but associated with higher mortality. Chromosomal abnormalities, longer ventilator use duration, and prolonged CPB were significant risk factors for the entire cohort. We hope to minimize the impact of unplanned return after congenital heart disease surgery by changing the process of transferring these high-risk postoperative patients out of the CICU and early postoperative care.