Patients who have a prolonged ICU stay following cardiac surgery have high early and late mortalities. However, the functional status of the survivors is satisfactory after 1 year and beyond.

Background – Children with exposure to COVID-19 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery (CHS) program are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimization prior to CHS. Objective: The objective of the present study was to determine whether convalescent COVID-19 children undergoing congenital heart surgery have any worse mortality or postoperative outcomes. Design: Consecutive children undergoing CHS from Oct 2020 to May 2021 were enrolled after testing for RT-PCR (Reverse Transcriptase Polymerase chain test) or rapid antigen test (RAT) and IgG antibody prior to surgery. Convalescent COVID-19 was defined in any asymptomatic patient positive for IgG antibodies and negative for RT-PCR or RAT anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and postoperative outcomes were compared among the groups. Results: 1129 consecutive CHS were stratified as convalescence and control. COVID-19 Convalescent (n=349) and COVID-19 control (n=780) groups were comparable for all demographic and clinical factors except younger and smaller kids in control. Convalescent children had no higher mortality, ventilation duration, ICU and hospital stay, no higher support with ECMO, HFNC, no higher need for re-intubations, re-admissions, and no higher infections as CLABSI, SSI, and VAP on comparison with COVID-19 control children. Conclusions: Convalescent COVID-19 do not have any unfavorable outcomes as compared to COVID-19 control children. Positive IgG antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.

Background: Branch pulmonary artery (PA) occlusion during patent ductus arteriosus (PDA) stenting procedure is the main reason why branch PA origin stenosis was considered as a contraindication for PDA stenting. This study was designed to assess the incidence of branch PA jailing during PDA stenting for cyanotics with duct-dependent pulmonary circulation and its immediate outcome. Methods: All the completed PDA stenting patients in our hospital between April 2017 and June 2019 were retrospectively analyzed for branch PA jailing and its outcome. Results: Of 63 completed PDA stenting, there was branch PA jailing in 13 (20.6%) patients, all successfully recruited either by strut dilatation or by surgery. The median duration of ventilation was 16 (interquartile range [IQR]: 8-22) hours for jailed patients and 17.5 (IQR: 5.25-34.25) hours for nonjailed patients ( P = .978). Median intensive care unit [ICU] stay was 69 (IQR: 47.75-96) hours for jailed patients and 79.5 (IQR: 66.75-135.25) hours for nonjailed patients ( P = .394). Procedural mortality was 1 (7.6%) for jailed patients and 3 (6%) for nonjailed patients. Since all the jailed pulmonary arteries were recruited, there was proportionate growth of branch PA till the most recent follow-up. Conclusion: Jailing of branch PA does not increase the ventilation duration, ICU stay, or mortality risk if recruited immediately. Proportionate growth of branch PAs can be achieved in spite of jailing, if addressed aggressively. Branch PA stenosis should not be considered as a contraindication for PDA stenting.

Early recruitment of a discontinuous branch pulmonary artery will give the best long-term outcome for congenitally disconnected pulmonary arteries. This may be achieved using a staged approach. Even in low birth weight neonates, a hybrid approach with the first stage consisting of transcervical (via the common carotid artery) patent ductus arteriosus stenting can be performed to recruit the pulmonary artery where conventional treatment strategies may not be feasible or may be associated with higher risk.

We have previously reported a simple technique for preparatory staging and subsequent interventional completion of an extracardiac Fontan procedure that anatomically and hemodynamically closely mimics a standard extracardiac Fontan. We describe herein modifications that simplify the original procedural sequence and that may allow wider application. Percutaneous completion can be achieved even without a radiofrequency probe, using electrocautery. Fenestration is also easy to perform if there is a clinical indication.