Objective: To determine risk factors affecting time-to-death ≤90 and >90 days in children who underwent a modified Blalock-Taussig shunt (MBTS). Methods: Data from a retrospective cohort study were obtained from children aged 0–3 years who experienced MBTS between 2005 and 2016. Time-to-death (prior to Glenn/repair), time-to-alive up until December 2017 without repair, and time-to-progression to Glenn/repair following MBTS were presented using competing risks survival analysis. Demographic, surgical and anesthesia-related factors were recorded. Time-to-death ≤90 days and >90 days was analyzed using multivariate time-dependent Cox regression models to identify independent predictors and presented by adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: Of 380 children, 119 died, 122 survived and 139 progressed to Glenn/repair. Time-to-death probability (95% CI) within 90 days was 0.18 (0.14–0.22). Predictors of time-to-death ≤90 days (n = 63) were low weight (90 days (n = 56) were children diagnosed with pulmonary atresia with ventricular septal defect and single ventricle (compared to tetralogy of fallot) (HR 3.2, 95% CI:1.2–7.7 and HR 3.1, 95% CI:1.3–7.6, respectively), shunt size/weight ratio >1.1 vs <0.65 (HR 6.8, 95% CI:1.4–32.6) and longer duration of mechanical ventilator (HR 1.002, 95% CI:1.001–1.004). Shunt size/weight ratio ≥1.0 (vs <1.0) and ≥0.65 (vs <0.65) were predictors for overall time-to-death in neonates and toddlers, respectively (HR 13.1, 95% CI:2.8–61.4 and HR 7.8, 95% CI:1.7–34.8, respectively). Conclusions: Perioperative factors were associated with time-to-death ≤90 days, whereas particular cardiac defect, larger shunt size/weight ratio, and longer mechanical ventilation were associated with time-to-death >90 days after receiving MBTS. Larger shunt size/weight ratio should be reevaluated within 90 days to minimize the risk of shunt over flow.

Background: Open cardiac surgery involving cardiopulmonary bypass (CPB) triggers a systemic inflammatory response that significantly affects clinical outcomes. However, the dynamics and specific roles of cytokine release after CPB in the pediatric population remain unclear.Purpose: To evaluate the dynamics of cytokine levels and their association with low cardiac output syndrome (LCOS)-related outcomes.Methods: A prospective observational cohort study was conducted of 32 children who underwent elective open cardiac surgery with CPB at Songklanagarind Hospital, Thailand. Levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α were analyzed preoperatively and immediately (T0), 6, 12, and 24 hours after intensive care unit admission. LCOS-related outcomes were defined with at least two of the following criteria being met within 24 hours postoperative: clinical and laboratory parameters, vasopressor-inotropic score ≥20, ejection fraction 56 pg/mL from baseline to T0 showed the strongest association with LCOS (odds ratio, 37.34; 95% confidence interval, 4.53–836.53).Conclusion: An elevated postoperative IL-8 level is a robust predictor of LCOS-related outcomes in pediatric patients undergoing cardiac surgery. These findings emphasize the importance of monitoring cytokine dynamics to guide interventions and improve patient outcomes.

Transcatheter closure of the patent ductus arteriosus (PDA) is widely accepted as an alternative to surgical ligation. However, major complications are uncommon. Therefore, procedural difficulty, including device repositioning or change, may provide additional insight into technical challenges encountered during PDA closure. We aimed to identify the clinical and anatomical risk factors associated with procedural difficulty or major adverse events during transcatheter PDA closure and to document the prevalence and types of complications encountered in a single tertiary center. This retrospective cohort study included 341 patients who underwent a transcatheter PDA closure between 2010 and 2023. A composite primary outcome, defined as procedural difficulty or major adverse events, included device malposition requiring reposition or change, unsuccessful device deployment, device embolization, hemodynamic instability requiring intervention, or unplanned surgical conversion. Demographic, anatomical, and hemodynamic variables were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Procedural difficulty or major adverse events occurred in 49 patients (14.3%). There was no procedure-related mortality. Device embolization occurred in three patients (0.8%), all requiring surgical ligation. Multivariate analysis revealed that a minimum PDA diameter >5 mm (odds ratio [OR] = 2.75, P = 0.013), PDA length >8 mm (OR = 2.81, P = 0.009), and non-type A (non-conical) duct morphology (OR = 2.88, P = 0.025) were independently associated with the composite outcome. In conclusion, larger PDA diameter, longer ductal length, and non-conical morphology were significantly associated with increased procedural difficulty or major adverse events during transcatheter PDA closure. These findings highlight the importance of detailed anatomical assessment in patients undergoing transcatheter PDA closure.