Aims Congenital heart disease (CHD) is the most common congenital malformation. Despite the worldwide burden to patient wellbeing and health system resource utilization, tracking of long-term outcomes is lacking, limiting the delivery and measurement of high-value care. To begin transitioning to value-based healthcare in CHD, the International Consortium for Health Outcomes Measurement aligned an international collaborative of CHD experts, patient representatives, and other stakeholders to construct a standard set of outcomes and risk-adjustment variables that are meaningful to patients. Methods and results The primary aim was to identify a minimum standard set of outcomes to be used by health systems worldwide. The methodological process included four key steps: 1) develop a working group representative of all CHD stakeholders; 2) conduct extensive literature reviews to identify scope, outcomes of interest, tools used to measure outcomes, and case-mix adjustment variables; 3) create the outcome set using a series of multi-round Delphi processes; and 4) disseminate set worldwide. The WG established a 15-item outcome set, incorporating physical, mental, social, and overall health outcomes accompanied by tools for measurement and case-mix adjustment variables. Patients with any CHD diagnoses of all ages are included. Following an open review process, over 80% of patients and providers surveyed agreed with the set in its final form. Conclusion This is the first international development of a stakeholder-informed standard set of outcomes for CHD. It can serve as a first step for a lifespan outcomes measurement approach to guide benchmarking and improvement among health systems.

We present the case of transient left ventricular dysfunction secondary to impaired left coronary artery filling after aortopulmonary window repair, caused by intraoperative diagnosis of anomalous left coronary artery from pulmonary artery. Immediate recognition and repair allowed for uneventful recovery of the patient.

More than 135 million children are born every year worldwide, and about 4 million will die during first month of life. Around 40-70% of those with congenital heart disease will require surgical treatment during the first year of life but many will die without appropriate treatment, especially in LMIC.Covering the costs is and will always be a big challenge for governments in LMIC, and NGOs organizing surgical journeys can provide adequate but temporary solutions. The necessity to supply the governmental health coverage was the reason to create a social responsibility program "Regale una vida". The aim of this article is to present the experience of a successful social program in pediatric cardiac surgery in a middleincome country and compare the surgical results with those covered by the government. Review of the process needed to build and successfully maintain a social program since 1994. Retrospective analysis of the program comparing results with patients supported by the government, from January 2010 through December 2019. More than 50,000 patients have been evaluated, and 3,000 patients and more than 1,000 echos performed in the last 9 years pre-pandemic. About 7% of the evaluated children were found to have some cardiac abnormality, receiving treatment (195/year). Around 70 of those patients/year received cardiac surgery totally covered by the program. RACHS-1 category 2 patients were more frequent in social program group (40% vs. 30%), but Rachs-1 category 4 were less frequent (2.8% vs. 6.2%) (P<0.001). Global mortality rates are lower in the social program (1.4% vs. 3.4%) (P<0.003). 89.7% of the patients are between 1 and 18 years and only 0.1% are neonates. "Regale una vida" is a successful example of a safe, permanent (available 24/7 throughout the year), highly effective, reproducible, and self-sustainable social responsibility program.It includes active search of patients, transfer to a high-quality hospital and surgical, Interventional, or medical treatment, benefiting a big number of CHD patients with low resources. Even during COVID-19 pandemic, with only a small reorganization, social responsibility programs can keep achieving their goal, maintaining excellent and cost-effective results.

Background The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon’s preference, based on individual experience, speed, ease, and quality of exposure. Methods The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality. Results A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up. Conclusion We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.

Background: The lack of evidence on postoperative outcomes using mitral valve approaches leaves the choice to the surgeon’s preference, based on individual experience, speed, ease, and quality of exposure.Methods: The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality.Results: A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias. The incidence of nodal rhythm (p= 0.008) and length of stay in intensive care (p= 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up.Conclusion: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.