In 2022,China's National Health Commission issued the health standard"Guideline for pediatric transfusion"(WS/T 795-2022),which provides guidance and recommendations on overall pediatric blood requirements,blood for exchange transfusion,and the use of irradiated red blood cells,washed red blood cells,and fresh red blood cells.This article explains the rationale and evidence base underlying these recommendations to facilitate a clearer understanding of the guideline.

Background To compare the hemodynamic effects of Treprostinil and postoperative outcomes in pediatric single-ventricle patients with pulmonary hypertension (PH, mean pulmonary artery pressure (mPAP) >15 mmHg) following Glenn or Fontan palliation, and identify key prognostic factors associated with treatment response and clinical outcomes. Methods Retrospective analysis of 79 pediatric patients (28 Glenn in Group 1 and 51 Fontan in Group 2) from 2015 to 2022, excluding those requiring postoperative extracorporeal membrane oxygenation. All received intravenous Treprostinil. Changes in mPAP, vasoactive-inotropic score, and postoperative recovery parameters were compared. Binary logistic regression identified prognostic factors, and receiver operating characteristic curve analysis evaluated the predictive value of Treprostinil dose. Results Regimen distribution did not differ between groups (14 vs. 14 in Group 1 and 35 vs. 16 in Group 2 on early/later standardized regimens, P = 0.103). Group 1 had more additional cardiac procedures (75% vs. 49%, P = 0.025), with similar Treprostinil maintenance doses (17.5 [10,25] vs. 15 [14,20] ng/(kg·min), P = 0.421). At 24 h, mPAP decreased significantly more in Group 1 (17 ± 3 to 13 ± 3 mmHg vs. 17 ± 3 to 15 ± 2 mmHg, P < 0.001). Vasoactive-inotropic score decreased in Group 1 (P < 0.001) but not in Group 2 (P = 0.063). Group 1 had higher resuscitation (29% vs. 6%, P = 0.014) and mortality (11% vs. 0, P = 0.041), but lower chest tube drainage, shorter placement duration, and hospital stay. Glenn surgery was an independent risk factor for resuscitation/death (odds ratio = 6.518, P = 0.012); Treprostinil (odds ratio = 0.871, P = 0.004) and maintenance dose > 15.5 ng/(kg·min) (area under the curve = 0.717) protected against adverse outcomes (thromboembolic events, renal replacement therapy, tracheal reintubation, mortality, resuscitation). Conclusion Treprostinil effectively reduces mPAP in both groups, with significantly greater hemodynamic efficacy in Glenn patients, who face higher resuscitation and mortality risks due to greater anatomical complexity. Fontan patients have lower mortality but prolonged morbidity from pleural effusions. The Treprostinil maintenance dose > 15.5 ng/(kg·min) is a protective factor for postoperative adverse outcomes.

Background: This study evaluated the impact of a comprehensive prevention program, which integrated eight evidence-based measures consistent with current clinical guidelines and practice standards, on ventilator-associated pneumonia (VAP) rates in a pediatric cardiac surgical intensive care unit (ICU). Methods: A quasi-experimental study was conducted from 2023 to 2024. We compared VAP rates across a 5-month pre-intervention period, a 12-month intervention period, and a 7-month post-intervention period in patients receiving mechanical ventilation for over 48 h. Additional outcomes, including postoperative length of stay were also assessed before and after the intervention. Results: Among 829 at-risk patients and 5677 ventilator-days, the VAP rates per 1000 ventilator-days were 25.7, 11.3, and 10.8 in the pre-intervention, intervention, and post-intervention periods, respectively. Poisson regression identified the intervention and post-intervention periods as protective factors for VAP. After adjusting for age, weight, emergency surgery, and cardiopulmonary bypass duration, VAP rates decreased by 56% during the intervention period (adjusted incidence rate ratio (IRR) 0.382, 95% CI 0.212-0.691; p = 0.001) and by 58% in the post-intervention period (adjusted IRR 0.452, 95% CI 0.232-0.882; p = 0.020). Postoperative length of stay also declined significantly from 22 (16, 35) days pre-intervention to 21(15, 28) days post-intervention (p = 0.040). Conclusions: Implementation of the multidisciplinary prevention program was associated with a sustained reduction in VAP rates in a surgical pediatric cardiac ICU and may contribute to shorter postoperative hospital stays.

OBJECTIVE:For pediatric patients with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH), corrective repair carries a substantial risk of inducing pulmonary hypertensive crisis (PHC). The conventional clinical strategy involves postoperative administration of inhaled nitric oxide (iNO) followed by a gradual tapering process, which is often associated with prolonged postoperative recovery. To address this limitation, this study proposes a fast-weaning strategy: the continuation of iNO delivery via high-flow nasal cannula (HFNC) following extubation. METHODS:This single-center, retrospective cohort study screened pediatric patients with systemic-to-pulmonary artery shunt type CHD and a pulmonary vascular resistance index (PVRi) > 6 WU × m2 between 2019 and 2024. Eligible patients admitted from 2023 to 2024 were assigned to Group 1 (fast-weaning), while those admitted from 2019 to 2022 constituted Group 2 (standard-weaning). For propensity-score matching, the predictive variables included age, preoperative PVRi, and the duration of cardiopulmonary bypass. RESULTS:Following propensity score matching, 22 matched pairs were included in the final analysis. Pulmonary hypertensive crisis recurrence occurred in two of 22 patients (9.1%) in Group 1 and three of 22 patients (13.6%) in Group 2 (p > 0.99). Patients in Group 1 had a significantly shorter duration of mechanical ventilation (18 [8.5, 22.3]) versus 21.5 (19.8, 27.3) hours; p = 0.014) and postoperative intensive care unit length of stay (2 [1, 4]) versus 3 [3, 5] days; p = 0.023). No major postoperative complications were reported in either group. CONCLUSION:Continuing iNO via HFNC following extubation is a safe weaning strategy. It may be associated with faster recovery, providing a potential alternative to conventional protocols.

We examined probiotic-associated bacteremia in a cohort of postoperative pediatric cardiac surgery patients in China. Among 16,436 children who underwent cardiac surgery during 2019-2024, a total of 5,034 received probiotics; 6 developed bacteremia with probiotic strains (Bacillus subtilis, Bacillus licheniformis, Lacticaseibacillus rhamnosus). Three cases occurred in children who had not directly received probiotics, suggesting potential cross-contamination or catheter-related transmission. All 6 patients had complex congenital heart disease and central venous catheters; 5 underwent palliative surgery. Fever, elevated C-reactive protein and leukocytes, and use of respiratory support were common. Antibiotic therapy achieved blood-culture clearance in all; 1 death occurred because of underlying cardiac disease, not infection. Our findings conclude probiotic-associated bacteremia is rare and usually resolves with antibiotics; outcomes correlate more with cardiac complexity than bacteremia itself. Maintaining perioperative probiotic use and enhancing infection-control measures, specifically regarding central line care, are recommended to minimize the risk for probiotic-associated bacteremia in pediatric cardiosurgical patients.

OBJECTIVE:Nutrition status is vital for children's recovery following cardiac surgery, with substantial inter-individual variability in metabolic demands. We aimed to develop machine learning (ML) models of postoperative resting energy expenditure (REE) by analysing the influential factors. METHODS:We retrospectively analyzed children who underwent indirect calorimetry (IC) for valid REE measurements within 4 to 24 h after cardiac surgery between January 2021 and December 2022 at our center. Nine ML algorithms were trained to predict REE. Bland-Altman analysis assessed agreement with measured REE, and SHAP was used for population-level interpretation and a representative patient case. RESULTS:A total of 278 mechanically ventilated children were analyzed. REE measured by IC ranged from 387 to 2642 kcal/d (715 [550, 964]). The root mean square error (RMSE) of the ML models ranged from 226 (95% CI: 184-267) to 281 (95% CI: 225-344) kcal/d, while the range for conventional equations was 249 (95% CI: 215-287) to 282 (95% CI: 252-315) kcal/d. Regularized linear models achieved the highest R2 of 0.64 (95% CI: 0.49-0.76). The top 10 most important variables associated with REE in the optimal model are weight, age, height, preoperative serum albumin, preoperative CK-MB, vasoactive inotropic score (VIS), CPB time, postoperative LVEDD Z-score, gender, and postoperative NT-proBNP. CONCLUSIONS:This study developed ML models to predict REE in children after cardiac surgery, with some models outperforming conventional equations. These findings highlight the potential of machine learning to optimize postoperative nutritional management by accurately capturing the non-linear metabolic response to surgical stress.

Timely and effective management is crucial for neonates with critical congenital heart disease (CCHD). This study investigated the impact of the RAPID-CHD Pathway, a coordinated referral and transport system, compared with conventional management models. This retrospective study included neonates (≤ 28 days) with CCHD admitted between January 2019 and December 2024. Group 1 comprised neonates enrolled in the RAPID-CHD Pathway: prenatally diagnosed, delivered in designated maternity hospitals, and transferred via a dedicated fast-track pathway. Group 2 included those referred from other hospitals or self-admitted. Major adverse events (MAEs) were defined as in-hospital death or discharge against medical advice. Logistic regression was used to assess associations between management strategies and MAEs. Among 587 neonates (Group 1: n = 141; Group 2: n = 446), 439 underwent surgery (Group 1: n = 116; Group 2: n = 323). Group 1 had earlier ICU admission (0 vs 6 days, P < 0.001), earlier surgery (7 vs 15 days, P < 0.001), lower rates of low birth weight (< 2.5 kg: 5.7

Objective: This study compares perspectives between interventional cardiologists and cardiac surgeons on congenital heart disease management via a national survey. Methods: An online questionnaire was distributed to senior surgeons or interventional cardiologists capable of comprehensive congenital heart disease care at 118 hospitals (236 total invitations). Results: Of 162 valid responses, 90 were surgeons and 72 were cardiologists. There were no differences between surgeons and cardiologists in demographic factors. Survey results showed no statistical differences in (1) the overall relationship between interventional and surgical approaches (complementary and sequential); (2) interventional treatment for complex congenital heart disease (using the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery, simple and complex congenital heart disease were defined as lesions with category I and categories II-V); and (3) multidisciplinary team management (long-term follow-up by a consistent core team). Differences were found in the following areas: 1. In decision-making, surgeons placed emphasis on age and developmental potential (adjusted P = .016), whereas cardiologists focused on physiological status and complications (adjusted P = .008). 2. For secundum atrial septal defect (P < .001), patent ductus arteriosus (P < .001), muscular/perimembranous ventricular septal defect (P = .001), pulmonary valve stenosis (P = .010), and coarctation of the aorta (P < .001), each specialty considered their own approach as the preferred option. 3. Surgeons expressed greater demand for interdisciplinary cross-training (adjusted P = .020). Conclusions: Despite broad consensus, cardiologists and surgeons differ in decision-making priorities and training needs. These findings support structured communication, optimized management, specialty-tailored training, and hybrid care models to improve patient outcomes.

Paravalvular leak (PVL) remains a significant complication after transcatheter aortic valve replacement (TAVR). This study investigated the relationship between perioperative serum albumin levels and post-TAVR paravalvular leak. This retrospective observational study analyzed 1463 consecutive patients who underwent TAVR between 2013 and 2023. Serum albumin levels were measured preoperatively, immediately after procedure, and on postoperative days 1–5 and before discharge. Additional biomarkers including NT-proBNP and high-sensitivity troponin T were collected. Postprocedural echocardiography was used to assess PVL severity according to American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Primary endpoints included correlation between various albumin parameters and PVL severity. The cohort included 851 males (58.2

Importance Infantile dilated cardiomyopathy (DCM) associated with left bundle branch block (LBBB) is a rare but life-threatening condition, especially when severe heart failure is present. Identifying effective solutions to improve the prognosis is crucial.Objective This study aims to evaluate the short-term clinical outcomes and cardiac functional changes in infants with LBBB-associated DCM treated with a combined approach of electrical and mechanical cardiac resynchronization.Methods We conducted a retrospective analysis of five infants who underwent epicardial cardiac resynchronization therapy (CRT) combined with pulmonary artery banding between 2023 and 2024. The primary endpoint was improvement in clinical functional class and cardiac function, assessed by left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide levels. Secondary endpoints included indicators of cardiac reverse remodeling, evaluated by LV end-diastolic dimension (LVEDd), its z-score, cardiac resynchronization, and QRS duration.Results The five enrolled infants had a median age of 6 months (range, 3-12 months). All received guideline-directed medical therapy and were followed for a median of 11 months (range, 6-24 months). All patients achieved normalization of functional class. The median LVEF increased from 26% to 65%, with improvements observed within 1 month. The median LVEDd decreased from 46 to 28 mm, and the corresponding z-score decreased from 11.2 (range, 7.6-13.2) to 0.7 (range, -1.1 to 2.3). The median QRS duration narrowed from 138 to 115 ms. Mechanical dyssynchrony was virtually resolved in all patients by the last follow-up.Interpretation The combined resynchronization strategy appears to be highly effective for treating infants with LBBB-associated DCM. Further studies are needed to differentiate the specific roles of electrical and mechanical synchronization in improving outcomes.

Patients with heart failure (HF) demonstrate dysregulation in bilirubin metabolism. The specific characteristics of intestinal bilirubin metabolism in HF remain unclear. This study involved metagenomic sequencing and metabolomic profiling of fecal samples from 45 children with HF and 32 healthy children. Serum total bilirubin levels were 11.3umol/L, 19.4umol/L and 5.0umol/L in HF New York Heart Association (NYHA) I-II, NYHA III-IV and control group (p < 0.001 ), and the median gut microbiome health index (GMHI) were − 0.78, -1.53 and 0.09 in each (p < 0.001). The abundance of 2 bacteria species containing bilirubin reductase, Ruminococcus gnavus (p = 0.028) and Clostridium sp.M62/1 (p = 0.002) significantly decreased in NYHA III-IV group. The gut downstream bilirubin products, urobilinogen and stercobilin were decreased in the HF group; while the upstream bilirubin products, unconjugated and conjugated bilirubin increased. Dysbiosis of the gut microbiome and the decrease of bilirubin reductase containing bacteria in pediatric HF patients related to a reduction in gut bilirubin metabolism. Metagenomic sequencing and metabolomic profiling have revealed correlations between alterations in intestinal microecology and the severity of pediatric heart failure (HF). Dysbiosis of the gut microbiome and the decrease of bilirubin reductase containing bacteria in pediatric HF patients results in a diminished capacity for gut bilirubin metabolism, which might related to the intestinal bilirubin dysregulation and hyperbilirubinemia.

BACKGROUND:Thrombocytopenia is common for patients in the intensive care unit (ICU) and is associated with adverse outcomes. ICU thrombocytopenia in pediatric patients who underwent cardiac surgeries with cardiopulmonary bypass (CPB) is inadequately studied. OBJECTIVES:We aimed to investigate the incidence, risk factors, and prognostic role of ICU thrombocytopenia after congenital cardiac surgeries with CPB. METHODS:A retrospective study involving 11 761 patients was conducted. Patients were categorized into 4 groups of thrombocytopenia based on platelet counts tested during ICU: non (>150 × 109/L), mild (100-150 × 109/L), moderate (50-100 × 109/L), and severe (<50 × 109/L). Logistic and Cox regression analyses were utilized to explore the risk factors of thrombocytopenia and the association of ICU thrombocytopenia with 30-day mortality. RESULTS:ICU thrombocytopenia was observed in 4007 patients (34.1%), with mild, moderate, and severe thrombocytopenia occurring in 2773 (23.6%), 987 (8.4%), and 247 (2.1%) patients, respectively. Younger age, cyanotic congenital heart disease, CPB duration, and preoperative laboratory findings (red blood cell, thrombocytopenia, red cell distribution width, hematocrit, and coagulation disorder) were identified as independent risk factors of ICU thrombocytopenia. Patients with moderate (hazard ratio [95% CI]: 11.38 [3.02-42.87]; P < .001) and severe thrombocytopenia (hazard ratio [95% CI]: 49.54 [13.11-187.14]; P < .001) had a significantly higher risk of 30-day mortality. Furthermore, with the increase in the severity of ICU thrombocytopenia, there was an incremental increase in the incidence of postoperative critical bleeding and thrombosis, perioperative blood transfusions, length of ICU stays, and duration of mechanical ventilation. CONCLUSION:ICU thrombocytopenia occurred in one-third of children after congenital cardiac surgery with CPB, and it was associated with multiple adverse outcomes.

PURPOSE:This study aimed to summarize 8-year clinical outcomes for patients who underwent transcatheter aortic valve replacement (TAVR) with the J-Valve system and evaluate the long-term durability and hemodynamic performance of the valve. METHODS:Between July 2014 and June 2015, 21 patients underwent transapical TAVR with the J-Valve system. Systematic clinical and echocardiographic follow-up was conducted on 18 patients for up to 8 years. RESULTS:Eight years post-TAVR with the J-Valve system, the all-cause mortality rate was 16.7%, with no prosthesis failures or thrombosis. Moderate to severe valve deterioration was observed in 50% of patients with aortic stenosis (AS), whereas no such deterioration was noted in patients with pure aortic regurgitation (PAR). At 8 years following TAVR, the effective orifice area measured 2.27 ± 0.50 cm2 in patients with PAR and 1.35 ± 0.38 cm2 in those with AS. Additionally, patients with AS exhibited a mean pressure gradient of 17.90 ± 10.61 mmHg. Over 8 years, PAR patients experienced a significant reduction in left ventricular end-diastolic diameter from 61.50 ± 2.08 mm to 48.67 ± 7.23 mm (p < 0.001), whereas AS patients showed no significant change. CONCLUSION:The J-Valve system demonstrates favorable long-term outcomes in TAVR, with excellent durability and hemodynamic performance in PAR patients.

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion is one of the most commonly used supportive treatments for children with hematological diseases. This guideline provides guidance and recommendations for blood transfusions in children with aplastic anemia, thalassemia, autoimmune hemolytic anemia, glucose-6-phosphate dehydrogenase deficiency, acute leukemia, myelodysplastic syndromes, immune thrombocytopenic purpura, and thrombotic thrombocytopenic purpura. This article presents the evidence and interpretation of the blood transfusion provisions for children with hematological diseases in the "Guideline for pediatric transfusion", aiming to assist in the understanding and implementing the blood transfusion section of this guideline.

Background: To explore the risk factors associated with adverse events following cardiac surgery in children with respiratory virus infections. The innovation particularly focuses on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, symptomatic infections, and the necessity of waiting for negative test results prior to surgery. Methods: A single-center, retrospective analysis was conducted on pediatric patients with congenital heart disease who underwent surgical treatment between 2021 and 2022. Patients with positive respiratory viral nucleic acid test results before the operation were included. Patients who did not have corresponding Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) scores were excluded from the study. The patients were categorized into two groups based on the occurrence of postoperative adverse events: Group 1, which experienced adverse events (including secondary respiratory bacterial/ fungal infections, reintubation, tracheotomy, high-frequency oscillatory ventilation, extracorporeal membrane oxygenation assistance, and death), and Group 2, which did not experience any adverse events. The two groups were compared across various parameters, including age, weight, gender, STAT scores, cardiopulmonary bypass surgery, palliative surgery, residual cardiac/multisystem malformations, SARS-CoV-2 infection, symptomatic infection, and persistent positive viral detection before surgery. Multivariate analysis was performed using logistic re-gression. Results: A total of 216 patients were included in the study, with 55 patients in Group 1 and 161 patients in Group 2. Through multivariate analysis, age (odds ratio [OR] 0.975, 95% confidence interval [CI] 0.956-0.995, P = 0.013) and symptomatic respiratory virus infection (OR 4.068, 95% CI 1.898-8.720, P < 0.001) were identified as risk factors for adverse events after cardiac surgery in children with respiratory virus infections. The results of the receiver operating characteristic curve analysis indicated that age < 12 months combined with symptomatic respiratory virus infection could predict postoperative adverse events with an area under the curve of 0.801, sensi-tivity of 0.845, and specificity of 0.655. Conclusions: Age < 12 months and symptomatic respiratory viral infections (both traditional respiratory viruses and SARS-CoV-2) were risk factors for adverse events after cardiac surgery in children with respiratory viral infec-tion. Persistent positive viral detection before surgery was not found to be an independent risk factor for adverse events.

Background:The Ozaki technique demonstrated promising results in adults, but few studies reported on pediatric patients with limited follow-up time. This study aimed to evaluate the mid-term results of Ozaki technique compared with Ross operation for complex aortic valve diseases in children.Materials and methods:One hundred and seventeen children underwent either Ozaki (n=64) or Ross (n=53) operation from January 2017 to December 2023. The primary endpoint was incidence of moderate or severe regurgitation/stenosis (AR/AS) post procedure.Results:No significant difference was observed in age (6.5 +/- 3.4 vs. 7.9 +/- 4.3 years) and weight (25.9 +/- 15.5 vs. 31.0 +/- 25.9 kgs) at surgery. The Ozaki group had significantly more patients in heart failure (20.3 vs. 1.9%, P = 0.003) before surgery and more patients needed ECMO installation (6.3% vs. 0, P=0.125) after surgery. The Ozaki group were in worse status with more patients occurred heart failure (20.3 vs. 1.9%, P = 0.003) before surgery and needed ECMO installation (6.3 vs. 0, P = 0.125) after surgery. During follow-up (20.4 +/- 17.3 vs. 22.7 +/- 22.8 months, P=0.526), five patients (7.8%) in Ozaki group but no patients in Ross group required reoperations. The incidence of moderate or severe AR (28.1 vs. 3.1%) and AS (31.3 vs. 5.7%) were significantly higher than Ross group. Multivariate analysis identified lower age [HR: 1.282 (95% CI: 1.075-1.529), P=0.006] and ECMO installation [HR: 0.126 (0.018-0.887), P=0.037] to be risk factors for moderate or severe AR, and higher aortic transvalvular gradient before discharge was confirmed as the only risk factor for moderate or severe AS (>= 36 mmHg) at follow-up in Ozaki group.Conclusion:Ozaki technique may be used as a palliative procedure for complex aortic valve diseases in children, but its' mid-term results were not durable as Ross surgery, especially younger patients.

Background: After pediatric cardiac surgery, many patients require a prolonged stay in the intensive care unit. These patients require tremendous resources, which adds an additional burden to the healthcare systems. To date, few studies have investigated risk factors in pediatric patients with congenital heart disease, especially in developing countries. This study aimed to explore the risk factors for prolonged intensive care unit stay after pediatric cardiac surgery to improve care planning and resource management. Methods: This retrospective study included pediatric patients with congenital heart disease who underwent surgical repair at our single center from January 2021 to December 2022. We analyzed 44 potential risk factors across pre-operative, intra-operative, and post-operative variables using logistic regression to identify independent risk factors. Results: Prolonged intensive care unit stay was defined as >= 95th percentile (>= 12 d). Of the 4348 patients studied, 246 experienced prolonged intensive care unit stay or hospital death after surgery were categorized as Group 1, while 4102 patients without prolonged stay or hospital death after surgery were designated as Group 2. Multivariable analysis identified 14 independent risk factors: age, pre-operative data cystatin C, palliative procedure, duration of cardiopulmonary bypass, lactic acid at weaning from cardiopulmonary bypass, postoperative arrhythmia, renal replacement therapy, re-operation, cardiopulmonary resuscitation, re-intubation, central venous pressure 2 h after transferred to the intensive care unit, volume of chest tube drainage 2 h after transferred to the intensive care unit, vasoactive-inotropic score on postoperative day 1, left ventricular ejection fraction on post-operative day 1. Conclusions: This study identified 14 risk factors associated with prolonged intensive care unit stays after pediatric cardiac surgery. These findings can help identify at-risk patients for targeted interventions to reduce intensive care unit duration and associated costs.