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Current risk adjustment models for congenital heart surgery do not fully incorporate multiple factors unique to neonates such as granular gestational age (GA) and birth weight (BW) z score data. This study sought to develop a Neonatal Risk Adjustment Model for congenital heart surgery to address these deficiencies.Cohort study of neonates undergoing cardiothoracic surgery during the neonatal period captured in the Pediatric Cardiac Critical Care Consortium database between 2014 and 2020. Candidate predictors were included in the model if they were associated with mortality in the univariate analyses. GA and BW z score were both added as multicategory variables. Mortality probabilities were predicted for different GA and BW z scores while keeping all other variables at their mean value.The C statistic for the mortality model was 0.8097 (95% confidence interval, 0.7942-0.8255) with excellent calibration. Mortality prediction for a neonate at 40 weeks GA and a BW z score 0 to 1 was 3.5% versus 9.8% for the same neonate at 37 weeks GA and a BW z score -2 to -1. For preterm infants the mortality prediction at 34 to 36 weeks with a BW z score 0 to 1 was 10.6%, whereas it was 36.1% for the same infant atlt;32 weeks with a BW z score of -2 to -1.This Neonatal Risk Adjustment Model incorporates more granular data on GA and adds the novel risk factor BW z score. These 2 factors refine mortality predictions compared with traditional risk models. It may be used to compare outcomes across centers for the neonatal population.

In 2004, the United Network for Organ Sharing (UNOS) added the label "high-risk donor" (HRD) for any organ donor who met the Centers for Disease Control (CDC) criteria for high-risk behavior for infection. The aim of this study was to calculate the rate of HRD graft use in heart transplantation in children and determine the differences in outcome from those who received standard-risk donor (SRD) grafts.We reviewed information from the UNOS database regarding transplants performed between June 30, 2004 and July 31, 2012. Heart transplant recipients18 years old were divided into two groups based on the donor's risk status. Demographic data on donors and recipients were collected. Survival analysis was performed to compare survival based on donor status. We also compared episodes of rejection before hospital discharge and the length of stay after transplantation by donor status.During the study period, 2,782 pediatric heart transplantations were performed and 116 (4.1%) patients received a CDC HRD graft. Recipients of HRD grafts were significantly older and heavier than those who received an SRD graft (8.5 vs 6.5 years, p0.001 and 35.7 vs 26.9 kg, p0.001). There was no difference in patient survival (log rank, p = 0.88) between groups. There was no difference in rejection prior to discharge (17.2 vs 16.4%, p = 0.81) or length of stay after transplantation (26.1 vs 27.6 days, p = 0.58).CDC HRD graft status does not appear to significantly affect recipient outcome after heart transplantation in children.

Background Adolescents often fare poorly after heart transplantation. However, whether the effect of age varies according to the etiology of heart failure is unknown. We tested the hypothesis that age-related heart transplantation outcomes are different in patients with myocarditis and congenital heart disease (CHD). Methods A retrospective analysis of the United Network of Organ Sharing database was performed for patients with myocarditis ( n = 709) and CHD ( n = 1,631) undergoing heart transplantation from 1987 to 2011. The effect of age on graft survival was assessed. Age was categorized as children (6–12 years), adolescents (13–18 years), younger adults (19–30 years), and older adults (31–50 years). Results For myocarditis, the median graft survival for adolescents was 6.9 years (95% confidence interval [CI], 5.6–9.6), which was significantly lower than other age groups (children: 14.1 [95% CI, 9.8–10.9] years, p = 0.004; younger adults: 11.8 [95% CI, 8.3–15.2] years, p = 0.172; older adults: 12.0 years [95% CI, 10.0–14.3 years], p = 0.033). For CHD, the median graft survival for adolescents was 7.4 years (95% CI, 6.8–8.6), which was not significantly different from other age groups (children: 9.0 [95% CI, 7.9–11.0] years, p = 0.737; younger adults: 11.2 [95% CI, 8.6–13.3] years, p = 0.744; older adults: 11.6 [95% CI, 9.2–15.3] years, p = 0.608). Multivariable analysis showed adolescent age was independently associated with worse graft survival for patients with myocarditis but not for CHD. Conclusions Adolescents with myocarditis have significantly worse graft survival after heart transplantation, but adolescents with CHD have similar outcomes to other patients with CHD. Further study is needed to improve outcomes in this vulnerable population.

s S225 (34-98%) derived from catheterizations. 31% (8-89%) of the total exposure occurred during the transplant admission, 59% (11-88%) during planned and 3% (0-56%) during unplanned follow-up testing. Age at transplant was a significant risk factor for increased radiation exposure, with older patients receiving higher dose (p= 0.006). When adjusted for age, congenital heart disease as indication for transplant (p= 0.08), pre-sensitization (p= 0.12), and a positive crossmatch (p= 0.09) showed a trend toward increased exposure. Conclusion: At our center, pediatric heart transplant patients are exposed to significant amounts of ionizing radiation over the first post-transplant year, the majority of which occurs during scheduled catheterization. As survival improves, it is important to consider the potential long term risks associated with these levels of exposure.

Purpose Adolescents often fare poorly after heart transplantation (HT) compared to other age groups. However, it is unknown if the impact of age varies across diseases leading to HT. We tested the hypothesis that age-related HT outcomes are different in patients with congenital heart disease (CHD) vs myocarditis. Methods and Materials A retrospective analysis of the United Network of Organ Sharing database was performed for patients with myocarditis (n=709) and CHD (n=1,631) undergoing HT from 1987-2011, to assess the effect of age on graft survival. Age was categorized as children (6-12 years), adolescents (13-18 years), younger adults (19-30 years), and older adults (31-50 years). Results Adolescents comprised 28% of CHD patients and 14% of myocarditis patients (p Conclusions Adolescents with myocarditis have significantly worse graft survival after HT, but adolescents with CHD have similar outcomes to other patients with CHD. Further study is needed to improve outcomes in this vulnerable population.