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This manuscript is one component of a larger series of articles produced by the Neonatal Cardiac Care Collaborative that are published in this supplement of Pediatrics. In this review article, we summarize the contemporary physiologic principles, evaluation, and management of acute care issues for neonates with complex congenital heart disease. A multidisciplinary team of authors was created by the Collaborative’s Executive Committee. The authors developed a detailed outline of the manuscript, and small teams of authors were assigned to draft specific sections. The authors reviewed the literature, with a focus on original manuscripts published in the last decade, and drafted preliminary content and recommendations. All authors subsequently reviewed and edited the entire manuscript until a consensus was achieved. Topics addressed include cardiopulmonary interactions, the pathophysiology of and strategies to minimize the development of ventilator-induced low cardiac output syndrome, common postoperative physiologies, perioperative bleeding and coagulation, and common postoperative complications.

The purpose of this study was to assess post-transplantation outcomes in recipients with increased pulmonary vascular resistance (PVR) in relation to donor size.The United Network for Organ Sharing database was used to identify patients ages 0 to 18 years at time of listing who underwent transplantation from 2010 to 2019 and for whom cardiac catheterization and donor-recipient weight ratio data were available. Patients were divided according to listing PVR into3, 3 to 6, and6 Wood units. Donor-recipient weight ratio was categorized as undersized (≤0.80), midsize (0.81-1.2), and oversized (1.2). Subgroup analysis was done with an additional supersized group (2.0).Fourteen hundred ninety-one patients met study criteria. Median age was 10 (interquartile range, 3-15) years and 45% were female. Four percent of heart transplantation cases used undersized, 45% used midsize, and 51% used oversized organs. More patients with PVR6 were received an oversized organ transplant compared with patients with PVR3; 59% (148/252) versus 48% (430/894); P = .003. There was no difference in survival among organ size groups regardless of PVR; this includes patients with PVR6 at listing who received an oversized organ transplant versus an undersized (P = .359) or midsized (P = .956) organ. In subgroup analysis, even in patients who received a supersized organ transplant, there was no survival difference noted regardless of PVR.Despite a persistent practice pattern to transplant oversized organs in high-PVR patients, there remains no difference in post-transplantation survival among these patients and those who received smaller organ transplants. Therefore, transplants in patients with high PVR should not be delayed by waiting for larger donors.

Graphical abstract, Highlights • Retroaortic innominate veins are rare in HLHS. • Prenatal echocardiographic diagnosis of congenital heart defects remains crucial. • Perinatal confirmation of anatomy is important in anticipating surgical difficulties.

This article describes a robotic 2-stage 3-field esophagolymphadenectomy. Techniques highlighted include thoracic esophagectomy; cervical, wide thoracic, and abdominal lymphadenectomy; thoracic duct ligation; gastric tube creation; esophagogastric anastomosis in the left neck; and jejunostomy feeding tube placement.

This article describes a robotic 2-stage 3-field esophagolymphadenectomy. Techniques highlighted include thoracic esophagectomy; cervical, wide thoracic, and abdominal lymphadenectomy; thoracic duct ligation; gastric tube creation; esophagogastric anastomosis in the left neck; and jejunostomy feeding tube placement.