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Abstract Pulmonary arterial hypertension (PAH) associated with congenital heart disease (PAH-CHD) is a complication that occurs after unrepaired significant systemic-to-pulmonary shunt. Treatment options for PAH-CHD-predominantly left-to-right (L-R) shunt in children with borderline-high pulmonary vascular resistant index (PVRi) have been debated. We aimed to assess the treatment and survival of children with PAH-CHD-predominantly L-R shunt with borderline to high PVRi, using Eisenmenger syndrome (ES) for comparison. In 1995–2021, a total of 142 patients with ES and 192 children with PAH-CHD-predominantly L-R shunt were eligible for our analysis. The PVRi in ES patients was 26.7 ± 16.8 WU m2. Most patients (91%) received PAH-targeted therapy. Of the 192 children with PAH-CHD-predominantly L-R shunt, the baseline PVRi was 9.2 ± 5.8 WU m2. A total of 64 patients (33.3%) had borderline PVRi (4–8 WU m2) and 98 patients (51%) had high PVRi (> 8 WU m2). Most patients (88.5%) responded to acute pulmonary vasodilatory testing and underwent repair, with 158 undergoing defect closure and 12 having fenestrated closure. A treat-and-repair strategy was used in 33 children (17.1%). The 10- and 15-year survival rates for patients with ES were 79.3% and 72.4%, respectively, which was significantly inferior to children with borderline PVRi [97.3% and 87.8% (p = 0.02)]; and high PVRi [91.6% and 89.5% (p = 0.06)], respectively. The survival rate of children receiving treat-and-repair was slightly higher than that of ES (p = 0.16). The independent mortality risk in children with PAH-CHD-predominantly L-R shunt was persistent PAH following the defect correction (adjusted hazard ratio 5.8, 95% CI 1.7–19.9, p = 0.005). Trial registration: TCTR20200420004.

Objective: This study aimed to compare the outcomes of PDA (patent ductus arteriosus) ligation performed in NICU (neonatal intensive care unit) versus OR (operating room) and identify relevant influencing factors. Materials and Methods: In this retrospective review, spanning a decade (2012-2021) of NICU patients at Siriraj Hospital who underwent PDA ligation, patients were categorized into two groups: OR and NICU. Baseline clinical characteristics, operative details, and postoperative results (including hospital mortality, cause of death, and complications) were collected and analyzed. Results: A total of 118 patients were included, with 52 patients in the OR group and 66 patients in the NICU group. There were no statistically significant differences in postoperative outcomes between the two groups. The hospital mortality rates were 1.9% (1/52) and 10.6% (7/66), respectively (p = 0.08). Post hoc multivariable binary logistic regression analysis further confirmed that the location of PDA ligation was not associated with hospital mortality. However, higher oxygen requirements and lower postmenstrual age (PMA) were found to be independently associated with hospital mortality (OR 1.10, p =0.02 and OR 0.82, p

Background: Patients with diabetes undergoing coronary artery bypass graft (CABG) are at risk of delayed wound healing. The telehealth program for wound healing promotion (TPWHP) was developed to improve wound healing in patients with diabetes undergoing CABG in a university hospital. Objective: This study aimed to examine the effects of the TPWHP on the healing of the sternal wound and saphenous vein graft (SVG) donor site in patients with diabetes undergoing CABG. Methods: In this randomized controlled trial, the participants were randomly assigned to the intervention (n = 30) and control (n = 30) groups. The control group received routine nursing care, whereas the intervention group received routine nursing care along with the TPWHP, which provides education and wound monitoring using multimedia and a surgical wound care booklet and monitors the wound through the LINE application on a smartphone after hospital discharge. Data were collected from June to November 2020 at two university hospitals in Bangkok, Thailand, using the demographic and health-related data form and the Thai wound assessment inventory (WAI). Data were analyzed using the Chi-squared, Fisher’s exact, and Mann–Whitney U tests. Results: The intervention group had significantly lower mean scores—indicating favorable wound healing—for SVG donor site wound healing level than the control group on days 14–21 after surgery (p = 0.012, mean = 0.58 ± 0.54 and 1.08 ± 0.82, respectively). No significant intergroup difference was observed in terms of the sternal wound healing level (p = 0.126); however, the intervention group showed lower mean scores—indicating good wound healing—than the control group. Conclusion: The TPWHP promotes effective wound healing of the SVG donor site; however, its efficacy on sternal wound healing was uncertain. Therefore, nurses should implement the TPWHP in collaboration with a multidisciplinary team to improve wound healing after hospital discharge. Trial registration: Thai Clinical Trials Registry (TCTR20211112002)

Background Postoperative infection contributes to the worsening of congenital cardiac surgery (CCS) outcomes. Surgical site infection (SSI), bloodstream infection (BSI) and ventilator associated pneumonia (VAP) are common. An additional bundle of preventive measures against central-line associated bloodstream infection (CLABSI) bundle was implemented in April 2019. Objectives To compare the incidence of major infections after pediatric CCS before and after the implementation of the CLABSI bundle and to identify risk factors for major infections. Methods We conducted a single-center, retrospective study to assess the incidence of major infections including bloodstream infection (BSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP) after pediatric CCS one year before and after implementation of the CLABSI bundle during April 2018–March 2020. The demographics and outcomes of the patients were explored, and risk factors for major infections were identified using multivariate analysis. Results A total of 548 children (53% male) underwent CCS with a median age of 1.9 years (range 0.01–17.5 years). The median Aristotle Basic Complexity score was 7.1 (range 3–14.5). The CLABSI bundle was applied in 262 patients. Overall mortality was 5.5%. 126 patients (23%) experienced major postoperative infections. During the year after the implementation of the CLABSI bundle, BSI was reduced from 8.4% to 3.1% (p = 0.01), with a smaller reduction in VAP (21% to 17.6%; p = 0.33). The incidence of SSI was unchanged (1.7% to 1.9%; p = 0.77). The independent risk factors for major infections were age at surgery 2 days (p 4 days (p = 0.04), and surgery during the pre-CLABSI bundle period (p = 0.01). Conclusion Following the implementation of the CLABSI prevention package in our pediatric CCS unit, the incidence of BSI was significantly reduced. The incidence of VAP tended to decrease, while the SSI was unchanged. Sustainability of the prevention package through nurse empowerment and compliance audits is an ongoing challenge.

Background: The guideline for antibiotic prophylaxis in pediatric cardiac surgery is currently unavailable, and the effects of cardiopulmonary bypass (CPB) may result in low plasma cefazolin concentrations and subsequent postoperative surgical site infections (SSIs). Aims: To demonstrate the calculated-unbound plasma concentrations of cefazolin during uncomplicated pediatric cardiac surgery. Settings and Design: A prospective observational study that included 18 patients

Background Truncus arteriosus (TA) is a complex congenital heart disease that carries morbidities in the first year of life. Previous authors have reported an operative mortality of 50%. In this report, we aim to report on the survival of patients with TA in our medical center in the recent era. Methods A retrospective review of all patients diagnosed with TA in Siriraj Hospital, Thailand from August 1995 to March 2018 was performed. Patients with single ventricle, hemiTA were excluded. The characteristics and outcomes of repaired and unrepaired TA patients with a known recent functional status in 2018 were reviewed. Operative mortality risks were analyzed using a multivariate model. Results A total of 74 patients (median age at referral: 70 days) were included in the cohort. One-third of the patients had associated anomalies including DiGeorge syndrome (13.5%). Anatomical repair was not performed in 22 patients (29.7%). The median age at time of repair for the 52 patients was 133 days (range: 22 days to 16.7 years). Complex TA was 10%. Early mortality occurred in 16 patients (30.8%). Five patients (9.6%) had late deaths at 0.3–1.2 years. Significant mortality risk was weight at time of operation

Objective: The ACCP guideline 2008 recommended cessation of warfarin five days before surgery. However, based on the observation of the clinical practice at Siriraj Hospital, we suggested a shorter period of three days before surgery. Prior studies have shown multiple factors had effected warfarin dosage, but few studies have shown factors that influenced normalization of prothrombin time after discontinuation of warfarin. Previous studies have shown the genetics factors, vitamin K epoxide reductase (VKORC1) and cytochrome P450 2C9 (CYP2C9) enzyme conjointly determine the warfarin maintenance dose. We wanted to find out the proper timing of warfarin cessation before surgery and relationhip to genetic factors. Methods: Sixty-eight patients on warfarin were randomized to stop warfarin for three or five days. Blood samples were acquired at three or five days after interruption of warfarin in each group and assayed for INR, VKORC1 and CYP2C9. We started bridging therapy when INR was less than 2.0 and accepted an INR value of 1.5 or less on the day of surgery. Results: A total of 68 patients were enrolled in the study. Thirty-three patients (48.5%) were male. The mean age was 50.8 ± 6.6 years (range 16-88 years). The mean BMI was 22.5 ± 3.6 kg. All patients had mechanical heart valve replacement, and 22 (32.4%) patients had AF. The mean cumulative weekly dose of warfarin was 27 ± 11.3 mg and baseline INR was 2.4 ± 0.3. Thirty (88.2%) patients in the three days group had INR ≤ 1.5 and thirty-three (97.3%) patients in the five days group had INR ≤ 1.5. There was no significant difference between interruption of warfarin for three and five days (p =0.16). Female sex, BMI and weekly warfarin dosage were associated to the longer cessation of warfarin. Only weekly warfarin dosage was a significant factor after multivariate analysis. From 68 patients, CYP2C9 *1/*1 was found in 93% and CYP2C9 *1/*3 was found in 7%. Neither mutant CYP2C9*2 allele nor individuals homozygous for CYP2C9*3 were observed. Regarding VKORC1, haplotype AB was found in 32% and haplotype AA was found in 63%. Haplotype BB (wild type) was found in 4%. Five patients who had INR > 1.5 after interruption of warfarin had VKORC1 haplotype AA, four patients had CYP2C9*1/*1 and one patient had CYP2C9 *1/*3. Neither VKORC1 nor CYP2C9 was related to normalization of INR (p=0.10, p=0.17). Conclusion: Temporary interruption of the warfarin therapy between three days and five days with bridging therapy before surgery is not significantly different in the Thai population. This study recommends discontinuing warfarin three days before surgery. The proper timing of interruption for warfarin does not only depend on the half-life of warfarin but also depends on age, co morbidity, sex, BMI, lower maintenance warfarin dose, and concomitant drugs. If patients have cardiac or liver disease, they may spend longer time to discontinue warfarin before surgery.

Background: Extracorporeal membrane oxygenator (ECMO) is one of challenging mechanical support devices that can increase a chance of survival in infant patients who undergo complicated congenital cardiac surgery, but cannot be separated from cardiopulmonary bypass. ECMO also rescues cardiac arrest patients after cardiac intervention or from other reasons. We would like to show our outcome in early experience. Methods: We retrospectively reviewed our medical records of all infant patients supported with ECMO after they underwent cardiac procedures between January 2011 and December 2013. Their demographic data, diagnosis, procedure variables, ECMO indication and duration, blood product administration, circuit-related complication, ICU length of stay, intubation period time, and perioperative outcome were analyzed. Results: There were six patients (Male = 5, Female = 1) with congenital heart disease who received ECMO following cardiac intervention (n=2) or cardiac surgery (n=4). Four patients with post-cardiac surgery had a mean cardiopulmonary bypass time of 347.25 minutes (SD= 132.10, range 235-530 minutes) and a mean aortic cross-clamp time of 90.75minutes (SD=47.74, range 52-159 minutes). The median age of ECMO induction was 32 days (range 1-182 days) and the mean weight of patients at ECMO induction was 3.15 kg (SD=0.67, range 2.5-4.3 kg). All patients received venoarterial type of ECMO support. The reasons for rescue ECMO were post-cardiac arrest (n=1), inability to wean from cardiopulmonary bypass (n=3), pulmonary hypertension (n=1), and cardiogenic shock (n=1). Five of them were successfully weaned from ECMO. Overall Survival in this group was 50% (3 out of 6 patients). Sepsis, cardiomyopathy and pulmonary hypertension were causes of death. Conclusion: ECMO is an efficacious method for rescuing some infant patients who undergo complex congenital heart surgery or cardiac intervention with critical unstable status or post-cardiac arrest. Keywords: ECMO, congenital heart disease, infant

Coronary artery bypass grafting is considered to be a more effective surgical procedure for the long-term benefits of people with obstructed coronary artery than other types of treatment. Yet, this measure does not provide an equally successful outcome for all people due to associated psychological and physical impediments. There is a lack of support programs in Bangladesh for people with coronary artery bypass grafting, and for this reason this randomized control trialled investigated the effectiveness of a healthy heart intervention program on the functional status and cardiac risk parameters among these people. A total of 160 participants with coronary artery disease were admitted to a specialized cardiac hospital in Dhaka for bypass grafting and they were randomly assigned to the experimental (n=80) and control group (n=80). The experimental group participated in the healthy heart intervention program in the hospital for 4 weeks in addition to routine care and also received follow-up phone calls at home after hospital discharge, while the control group received only routine hospital care. The data collection tools included demographic data and the health history questionnaire, the Bengali version of SF-36, and the cardiac risk assessment form. The outcomes of the program were measured at baseline, and at 12 and 16 weeks. Data analysis was performed using descriptive statistics, t-test, chi-square, and two-way repeated measures ANOVA. At baseline, there were no statistically significant differences between the groups in terms of demographic characteristics, health history, functional status, or risk parameters. The mean score for functional status was significantly higher, and the risk parameters for blood pressure and blood glucose were significantly lower in the experimental group than the scores in the control group at twelve and sixteen weeks. The healthy heart intervention program was seen to be useful for improving the functional status and reducing the risk parameters of individuals that have undergone coronary artery bypass grafts. The findings provide evidence for reforming the healthcare of the target population and for further research in order to validate the results before implementation in practice. [ABSTRACT FROM AUTHOR]