BACKGROUND:Percutaneous atrial septal defect (ASD) closure is an established alternative to surgical repair for patients with secundum ASD, offering minimally invasive treatment with high procedural success rates. Despite its widespread adoption, clinically significant complications such as device embolization and erosion may occur. Our Survey aims at providing a comprehensive, multicenter perspective on the incidence, features, and management strategies for these complications, in order to improve procedural outcomes and patient safety through collaborative data collection. METHODS:This is an international, multicenter survey collecting retrospective data from 30 centers performing transcatheter ASD closures between 2011 and 2021. Participating institutions contributed anonymous aggregate data on patient demographics, procedural details, and clinical outcomes, focusing on the incidence, anatomical and procedural risk factors, and management of device embolization or erosion. RESULTS:A total of 30 institutions participated, providing data on 13.155 procedures of transcatheter closure of ASD, with 40% of them in children. Amplatzer device was used in 58% of cases, with balloon sizing performed routinely in 62% of institutions, mainly with stop flow technique. A total of 17 erosions (0.13%) were reported, of which 10 in children (incidence 0.19%) and 7 in adults (incidence 0.09%). Surgical repair was performed in all these cases, one patient died. Embolizations were reported in 91 cases (incidence 0.7%), with 60% of them in children. Most (80%) occurred within 24 h. Surgical retrieval was carried out in 29% of cases. Irrespective of management, no fatal complications occurred. CONCLUSIONS:Complications such as embolization and erosion after transcatheter ASD closure in children and adults are exceedingly rare but still present in clinical practice and require careful monitoring for prompt recognition and timely intervention, in order to obtain favorable outcomes.

Survival for children on the waiting list has improved significantly over time in Sweden and the Nordic countries, despite an increase in waiting list duration over time. Approximately 40% of hearts used for pediatric heart transplantation in Sweden come from donors in other Nordic countries. Outcomes following pediatric heart transplantation in Sweden and the Nordic countries are comparable to much larger regions and registries, despite a low number of yearly transplants in the region.

BACKGROUND:Antimicrobial management in pediatric transplantation lacks standardized international guidelines, and current practices across European transplant centers remain poorly described. This study aimed to evaluate microbiological screening and peri-transplant antimicrobial strategies among centers participating in the European Reference Network on Transplantation in Children (ERN TransplantChild), including both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) programs. METHODS:Between December 2022 and February 2023, healthcare professionals within the network completed a structured survey addressing microbiological screening practices and peri-transplant antimicrobial strategies in pediatric transplant recipients. RESULTS:Of 127 transplant programs invited, 76 (59.8%) responded, including 62 SOT and 14 HSCT programs from 36 centers across 16 European countries. Pre-transplant screening strategies, microbiological methods, and decolonization practices varied substantially between centers. Reported prevalence of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing organisms was below 10% in most programs. In SOT, perioperative prophylaxis varied according to transplanted organ type. Cephalosporins were most commonly used in kidney and heart transplantation, whereas broader-spectrum regimens, including piperacillin-tazobactam and vancomycin, were more frequently adopted in liver, intestinal, and lung transplantation. Postoperative prophylaxis was continued beyond 24 h in most SOT programs. Antifungal prophylaxis was more commonly adopted in liver, intestinal, and lung transplant recipients. In HSCT, antibacterial peri-transplant use was not routinely prescribed in a substantial proportion of programs, particularly in autologous transplantation, whereas antifungals were widely used in allogeneic HSCT. CONCLUSIONS:Marked heterogeneity in microbiological screening and peri-transplant antimicrobial strategies across European pediatric transplant centers underscores the need for transplant-specific, evidence-based guidelines distinguishing between SOT and HSCT settings. These findings provide a foundation for the development of shared clinical pathways and harmonized recommendations.

BACKGROUND:Pediatric heart-lung transplantation (pHLTx) remains the only treatment option for children with significant and fixed elevation of pulmonary vascular resistance (PVR) in the setting of uncorrectable end-stage heart disease. We aimed to determine the characteristics, waiting list course and long-term outcomes for children listed for pHLTx within the Scandiatransplant region. METHODS:This was a multinational, retrospective observational cohort study comprising all children <18 years of age residing in Denmark, Estonia, Finland, Iceland, Norway and Sweden that were listed for pHLTx from January first 1987 until December 31st 2024. Data were extracted from the Scandiatransplant registry database. RESULTS:Thirty-two children were listed for pHLTx during the study period. Seventeen (53.1%) reached transplantation with a peak in listing and transplantation during the 1990ies. Median age at listing was 12.1 years (range 1.5-17.6, IQR 7.6-15.8). No infants <1 year were listed for pHLTx and there was no re-listing for re-transplantation during the study period. Congenital heart disease (CHD) with Eisenmenger´s syndrome was the cause of listing and transplantation in most cases (60.7% and 58.8%, respectively). Median waiting list duration was 268 days (range 3-3409, IQR 109-822). All-cause posttransplant 30-day mortality was 17.6% (n = 3). Kaplan-Meier estimated survival was 76.5% at 1 year, 35.3% at 5 years and 23.5% at 10 years posttransplant. CONCLUSION:Low numbers of pHLTx has been performed in Scandinavia. Long-term outcomes were unfavorable, but comparable to other larger international and North American registries. The declining number of performed pHLTx may result from a combination of poor prognosis, declining incidence of Eisenmenger´s syndrome, improved surgical techniques for cardiac repair combined with lung transplantation, and increasing use of lung transplantation for isolated pulmonary vascular disease.

Background Posttransplant lymphoproliferative disorder (PTLD) is a potentially lethal complication after pediatric heart transplantation (PHT). We have previously reported an association between PTLD and 1. sternotomy during infancy, 2. mismatch concerning Epstein–Barr virus infection, 3. hypoplastic left ventricle and 4. surgically palliated congenital heart disease (CHD) as transplant indication versus cardiomyopathy (CMP). Aim To explore whether there were significant differences in immunological profiles between the identified risk groups for PTLD and the rest of pediatric heart recipients. Methods Data was partially collected as registry data from the previous study concerning PHT, PKT and HC 7. We then added clinical data and prospectively collected blood samples from additional PHT subjects from the three Swedish tertiary centers performing long-term follow-up after PHT. Blood samples were collected after transplantation (mean time 4.6 years, range 0.2-14.7 years) and were analyzed for immunophenotyping of T- and B-lymphocyte subpopulations and monocytes by flow cytometry, and T-cell receptor excision circles (TREC). Results A total of 76 PHT subjects were included. Thirty-eight had undergone thymus excision during infancy and 22 had hypoplastic left ventricle. The transplant indication was CHD in 36 and CMP in 40 children. The immune profiles of the identified risk groups for PTLD were characterized by low numbers of TREC, naïve CD4+, naïve CD8+, naïve recent thymic emigrants (RTE) and among patients with CHD low numbers of T-helper cells (Th). In addition, the relative proportions of naïve cells were low. Conclusions The identified PTLD risk groups demonstrated significant impairment in the immune system, a pattern consistent with immune dysfunction and features of immunological aging, both of which are conditions known to increase the risk of developing PTLD.

OBJECTIVE:Traditional rejection surveillance after heart transplantation (HTx) is based on endomyocardial biopsies (EMBs), which are invasive, expensive, and associated with complications. Monitoring using cell-free DNA (cfDNA) is promising, but most studies report only on the donor fraction (DF) as the percentage of donor-derived cfDNA (dd-cfDNA) relative to total cfDNA. We evaluated the performance of dd-cfDNA to detect rejection. METHODS:HTx patients were prospectively enrolled in a multicenter study, and blood samples were collected concurrently with EMB. Dd-cfDNA was quantified using droplet digital PCR (ddPCR). Rejection was defined by EMB results and compared to nonrejection EMB. Patients with symptomatic rejection were studied as a subgroup, and test performance was determined using receiver operation characteristic analysis. RESULTS:We included 94 patients (70 adults and 24 children), which resulted in 1007 EMB and blood samples. In 19 patients, there were 32 rejection episodes >14 days past HTx, with 15 of them being symptomatic. In receiver operation characteristic analysis, dd-cfDNA and DF could discriminate quiescence from rejection with an area under the curve (AUC) of 0.68 and 0.65, respectively. Dd-cDNA at a threshold of 25 copies/ml showed an AUC of 0.87 to detect symptomatic rejection, significantly better than DF (AUC of 0.75). CONCLUSIONS:dd-cfDNA found good discrimination between cardiac recipients with and without rejection. Absolute quantification of dd-cfDNA with ddPCR is a fast and effective method to monitor graft health. Analyzing absolute dd-cfDNA levels helps identify other factors, besides rejection, that may influence cfDNA levels, potentially reducing the need for EMB.

Objective BACKGROUND: Previous studies have suggested that a milrinone infusion after paediatric cardiac surgery may decrease the risk of the patient developing low cardiac output syndrome (LCOS). It is not clear, however, whether this is due to the inotropic or vasodilator effects of milrinone. This study randomized paediatric cardiac patients to a postoperative infusion of either milrinone or phentolamine, a vasodilator drug without inotropic effect.OBJECTIVES: The objectives were to 1) compare the haemodynamic response of milrinone and phentolamine after paediatric cardiac surgery with cardiac index as the primary endpoint, and 2) analyze differences in markers for organ hypoperfusion. Design and method METHOD: Forty children under the age of one year, scheduled for surgical correction of a ventricular or an atrio-ventricular septal defect using cardiopulmonary bypass were randomized to an infusion of either milrinone or phentolamine for the first 24 hours after surgery. Haemodynamic parameters including cardiac index were recorded using a transpulmonary dilution technique (PiCCO) at 8 and 18 hours after surgery, and echocardiography 18 hours after surgery. In addition, parameters such as serum lactate, urine output, and incidence of kidney failure (defined using the KIDGO score) were recorded. Results and conclusions RESULTS: There were no statistically significant differences between the groups in haemodynamic parameters, serum lactate levels, or the incidence of acute kidney injury. No adverse events were recorded in either group.CONCLUSION: No advantage or disadvantage for the patients could be found when using either milrinone or phentolamine after paediatric cardiac surgery.

BACKGROUND:Thirty-eight years of pediatric heart transplantation (pHTx) within the Scandiatransplant organization were analyzed to describe volume trends, regional prevalence, underlying etiologies, and outcomes following listing and pHTx. METHODS:Children <18 years listed for pHTx from January 1st 1986 to December 31st 2023 were identified in the Scandiatransplant registry. The cohort was split into groups based on the era of listing (ERA I; 1986-1998, ERA II; 1999-2011, and ERA III; 2012-2023). RESULTS:A total of 597 children were listed and 461 (77.2%) reached pHTx. The regional incidence of pHTx was 4.0 per 100,000 live births. All centers performed a median of <4 pHTx per year. 6.5% were transplanted at <1 year of age. Waiting list duration increased over time, withdrawal frequency remained stable, and listing mortality decreased from 22.8% in ERA I to 6.8% in ERA III. The distribution of listing and transplant diagnoses were not different between eras. ABO-incompatible transplants increased over time, from 1.0% in ERA I to 8.8% in ERA III, as did transplant from ventricular assist devices (6.6% in ERA I, 19.9% in ERA III). Post-transplant survival was 78.0% at 10 years and 51.4% at 30 years. Survival was worse in patients with an etiology of congenital heart disease compared with cardiomyopathies. Era of listing was a determinant of listing mortality but not of post-transplant survival. CONCLUSIONS:Numbers of pHTx in the Scandiatransplant region are low but have increased with time. There has been a significant decrease in waiting list mortality over time, whereas improvements in post-pHTx outcomes have been less evident, most likely due to excellent short-term outcomes for the first graft recipients in the region.

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-6kg. 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.

BACKGROUND:The first 35 years of pediatric heart transplantation (pHTx) in Sweden were investigated to determine outcomes following listing and transplantation, investigate sub-populations of recipients, and describe the presence of donor-specific antibodies (DSA) in a contemporary cohort. METHODS:Swedish children < 18 years, listed from 1/1/1989 to 31/12/2023, were included. The cohort was split based on the era of transplantation (ERA I: 1989-2008, ERA II: 2009-2023). RESULTS:A total of 254 children were listed and 185 (72.8%) reached pHTx, with no loss to follow-up. Waiting list duration was 62 days and increased over time, while mortality on the waiting list decreased (30.5% in ERA I, 8.8% in ERA II). Congenital heart disease was the etiology of heart failure in 36.2% of recipients, including 24.9% with univentricular physiology. The frequency of ABO-incompatible transplantations was 9.3% and 8.0% were considered to be at high immunological risk pre-pHTx due to pre-formed HLA-antibodies with mean fluorescence intensity ≥ 5000. Ventricular assist device (VAD) was used in 26.9% of recipients. Long-term survival was not affected by age, heart failure etiology, the use of pre-transplant VAD, or elevated baseline indexed pulmonary vascular resistance. Era of transplantation was a determinant of listing, but not post-pHTx outcome. Survival at 1-, 10-, and 30-year follow-up was 94.5%, 79.4%, and 57.1%, respectively. Of the total de novo DSA burden, 45.9% were HLA-DQ-type specific. Re-transplantation was performed in 5.9% of recipients. CONCLUSIONS:A high quality of care has been achieved in Sweden, despite modest pHTx numbers, in cooperation with the Scandiatransplant organization.

Despite significant advances in knowledge and the development of guidelines, the management of hypoplastic left heart syndrome (HLHS) remains highly variable. A structured questionnaire was circulated across European Association of Paediatric & Congenital Cardiology (AEPC) affiliated centres. The aims were to evaluate standards in pre-operative assessment, types of surgery, follow-up and medical practices in children with HLHS. Thirty-one centres from 20 countries completed the survey. Delivery of babies with HLHS occurred in co-located maternity hospitals in 74% of centres; 29% were planned for spontaneous onset of labour, while 54% decided on a case-by-case basis. The preferred initial palliation was a right ventricle-pulmonary artery conduit in 55% of cases, modified Blalock-Thomas Taussig shunt (mBTTS) in 35%, and hybrid in 15% of cases. Timing for Glenn varied from 3 to 6 months of age and preoperative examination varied greatly: 65% performed cardiac catheterization and only 19% performed cardiac magnetic resonance. Stage III palliation was performed at a highly variable interval (2—6 years of age), nearly always employing an extracardiac conduit. Fenestration was routinely performed in 61% and reserved for borderline cases in 39%. All the centers adopted warfarin for the first 3–12 months after Fontan completion, and continued if a fenestration was present, while in non-fenestrated aspirin was left by most centers (e.g. 68%). However, there was a high disparity in the use of heart failure medications (e.g. in interstage I-II 35% use ACE-inhibitors, and only 26% digoxin). Follow-up practice also varied widely with only 60% employing specific protocols. Conclusion : This first multi-centre European survey from 31 centres from 20 different European countries highlighted a high practice variation in HLHS management across all the stages of Single Ventricle (Fontan) palliation. Major variations pertained to pre- and post-surgical investigations, surgical strategy for stage I and III, medical treatment regimens, and follow-up programs. What is Known: • Hypoplastic left heart syndrome (HLHS) remains one of the most complex and challenging congenital cardiac defects to manage. • Investigating the management of children with HLHS across different European centres can facilitate study of the most effective management strategies. What is New: • Significant variation in HLHS management were reported in relation to pre- and post-surgical examinations, surgical strategy at stage I and III, medical treatment regimens, and follow-up programs. • Greater standardisation of imaging and diagnostic evaluation, medical treatment and follow-up surveillance may improve outcomes for these vulnerable patients and warrants further study.

INTRODUCTION:Cardiac surgery in infants often triggers a severe inflammatory response. The role of biomarkers in predicting clinical outcomes in this group of patients has been debated in the literature. This study aimed to investigate the predictive value of 20 inflammatory biomarkers, in combination with clinical data, for acute kidney injury, ventilator support duration, and inotropic score following infant cardiac surgery by developing and comparing three models: Clinical-Data-Only, Biomarker-Only, and Combined. METHODS:This secondary analysis of the MiLe-1 study included infants undergoing surgery with cardiopulmonary bypass. Biomarkers were measured before and after CPB. Using BIC-guided logistic regression, we developed and compared three multivariable models-Clinical-Data-Only, Biomarker-Only, and Combined-for each outcome. Model performance was assessed using c-statistics and p-contrast tests. RESULTS:Regarding AKI risk prediction, the c-statistics for Biomarker-Only, Clinical-Data-Only, and Combined Model were 0.79, 0.60, and 0.78 respectively. The difference in performance between the Combined and Clinical-Data-Only Models was statistically significant (p < 0.001). Concerning ventilator support time prediction, the c-statistics were 0.80, 0.72, and 0.77 for the models respectively (p-contrast = 0.10). As for inotropic score prediction, the c-statistics were 0.83, 0.77, and 0.85 for the models (p-contrast = 0.007). CONCLUSION:Inflammatory biomarkers may enhance risk stratification for postoperative outcomes in infant cardiac surgery. However, given the exploratory nature of this study, further validation in larger and more diverse cohorts is needed.

Evidence on the predictive ability of risk assessment models for event-free survival (EFS) in patients with pulmonary arterial hypertension is scarce. We aimed to investigate the relationship between risk status at 6 months after diagnosis (6 M) and EFS, by three risk models: Multicomponent Improvement (MCI), ESC/ERS 4-Strata Risk (4SR), and noninvasive French PH Registry Score (FRS). Data collected in the Swedish PAH Registry 2008-2021 were used. The study population was risk-stratified at 6 M according to each model. Information on PAH-related hospitalization (HOSP) was collected from the National Patient Register. EFS was defined as survival without occurrence of: (1) HOSP; (2) initiation of parenteral prostacyclin therapy or dose increase ≥ 10%; (3) lung transplantation. The association between risk and EFS was evaluated by Kaplan-Meier estimates and Cox proportional models. The analysis included 411 incident patients, median age 66 y [50, 73]. Median survival time was 3.5 y [1.7; 5.4], and cumulative EFS was 55%. In a Cox proportional regression adjusted for age, eGFR, obesity, atrial fibrillation, and systemic hypertension, EFS was higher in patients who: (1) achieved two or three MCI criteria compared to one or no MCI criterion (HR 0.58; CI 0.39-0.84, p = 0.005); (2) were assessed as low, intermediate-low, or intermediate-high compared to high risk (HR 0.16; CI 0.09-0.28, p < 0.001); or (3) fulfilled one, two, or three low-risk FRS criteria, compared to no low-risk criterion (HR 0.29; CI 0.19-0.43, p < 0.001). Performing a risk assessment 6 months after diagnosis effectively predicts the likelihood of EFS in the studied population, highlighting its prognostic value.

Objective Haemodynamic instability is common after surgical repair of congenital heart defects in infants and children. Monitoring cardiac output in addition to traditional circulation parameters could improve the postoperative care of these patients. Echocardiography and transpulmonary thermodilution are the two most common methods for measuring cardiac output in infants.The objective was thus to compare the results of cardiac output measurements using echocardiography and a transpulmonary thermodilution (PiCCO) setup after pediatric cardiac surgery. Design and method Forty children, scheduled for elective repair of a ventricular septal defect or of an atrio-ventricular septal defect using cardiopulmonary bypass, were enrolled in this prospective, observational study. Cardiac output was simultaneously measured using echocardiography and a commercially available TPTD method (PiCCO™) at 18 hours after the end of surgery. Results and conclusions At 18 h after surgery, PiCCO™ gave a mean of 3.0% higher cardiac output than echocardiography. This difference was not statistically significant. 95% of the observations fell within -50.0 – 82.6%.The methods were found to have a good agreement on average, with no statistically significant difference between them. However, the spread of the results was large. Therefore, it is questionable whether the methods can be used interchangeably in clinical practice.

BACKGROUND:Multicomponent improvement (MCI) is a novel endpoint for predicting survival in patients with pulmonary arterial hypertension (PAH), included in the sotatercept clinical program. For the first time, we investigated the prognostic value of MCI, European Society of Cardiology/European Respiratory Society (ESC/ERS) 4-strata risk (4SR) assessment, and the non-invasive French risk stratification score (FRS), for predicting survival in PAH patients in Sweden. All risk prediction models are based on 3 parameters: WHO-FC (World Health Organization Functional Class), NT-proBNP, and 6MWD (6-minute walk distance). METHODS:Data from the Swedish PAH & CTEPH Registry (SPAHR) collected 2008-2021 were used for the analyses. The association of MCI achievement, 4SR, and FRS calculated at 6 months, with transplant-free (TF) survival was investigated in the whole cohort, as well as categorized by age (<65 and ≥65 years). All risk prediction models are based on three parameters: WHO-FC (World Health Organization Function Class), NT-proBNP, and 6MWD (6-minute walk distance). Kaplan-Meier estimate/Log-Rank test and Cox proportional model were used for survival analyses. RESULTS:The study included 411 patients (70% women) with a median [IQR] age of 66 years.21 At 6 months, the mean (SD) NT-proBNP decrease was 808 (603) and the mean 6MWD increase was 44 (11) meters. Median survival/follow-up time was 3.5 years [1.7, 5.4]. After adjustment for sex and comorbidities, achievement of MCI independently predicted TF-survival; one MCI-criterion met (HR 0.65; CI 0.46-0.92, p = 0.015); 2 MCI-criteria met (HR 0.45; CI 0.31-0.66, p < 0.001); all 3 MCI-criteria met (HR 0.32; CI 0.21-0.52, p < 0.001). Likewise, 4SR and FRS demonstrated a strong association with TF-survival with patients achieving lower risk scores exhibiting longer survival compared to those with higher risk scores. Patients ≥65 years more often had connective tissue disease-associated PAH, lower DLCO, more pronounced comorbidity burden, higher risk at baseline, less improvement during follow-up, and worse TF-survival then patients <65 years. CONCLUSIONS:All models were found to have prognostic relevance for TF-survival. Risk prediction was incremental with the number of low-risk criteria met, while improvements in only one of 6MWD, NT-proBNP, or FC showed a modest association with survival. The risk assessment tools predicted outcome in patients across both age categories.

BACKGROUND:This study focuses on biomarkers in infants after open heart surgery, and examines the association of high-sensitive troponin T (hs-cTnT), interleukin-6 (IL-6), and interleukin-8 (IL-8) with postoperative acute kidney injury (AKI), ventilatory support time and need of vasoactive drugs. METHODS:Secondary exploratory study from a double-blinded clinical randomized trial (Mile-1) on 70 infants undergoing open heart surgery with cardiopulmonary bypass (CPB). In this sub-study, the entire study population was examined without considering the study drugs. The biomarkers' peak concentration (highest concentration at 2 or 6 h post-CPB) were used for statistical analyses. RESULTS:Peak IL-8, hs-cTnT, and IL-6 occurred at 2 h post-CPB for 96%, 79%, and 63% of the patients, respectively. The odds ratio of developing AKI2-3 for IL-6 > 293 pg/mL was 23.4 (95% CI 5.3;104.0), for IL-8 > 100 pg/mL it was 11.5 (3.0;44.2), and for hs-cTnT >5597 pg/mL it was 6.1 (1.5; 24.5). In more than two third of the patients with the highest peak concentrations of IL-8, IL-6, and hs-cTnT, there was a need for ventilatory support for >24 h and use of vasoactive drugs at 24 h post-CPB, while in less than one third of the patients with the lowest peak concentrations of IL-8 and hs-cTnT such requirements were observed. CONCLUSIONS:The peak biomarker concentrations and CPB-time strongly predicted AKI2-3, with IL-6 and IL-8 emerging as strongest predictors. Furthermore, our findings suggest that measuring hs-cTnT and IL-8 just 2 h post-CPB-weaning may assist in identifying infants suitable for early extubation and highlight those at risk of prolonged ventilation.