Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.

Introduction: We evaluated the outcomes of the selective intercostal artery reconstruction for preventing spinal cord injury during thoracoabdominal aortic aneurysm repair. Methods: We retrospectively assessed 84 consecutive patients who underwent thoracoabdominal aortic aneurysm repairs between 2004 and 2016. The mean age of the patients was 57.3 years. We performed preoperative multidetector computed tomography in 74 patients (88.0%) to identify the Adamkiewicz artery. Spinal cord injury preventive measures included motor evoked potential monitoring, hypothermia induction, Adamkiewicz artery or other intercostal artery reconstruction, and cerebrospinal fluid drainage. Results: The hospital death rate was 5.9%, and paraplegia occurred in four patients (4.7%). The Adamkiewicz artery or other intercostal arteries were reconstructed selectively in 46 patients (54.7%). Of these patients, 41 underwent postoperative multidetector computed tomography, which revealed occlusion of the reconstructed grafts in 23 patients (56.0%). There was no paraplegia in the patients who underwent reconstruction of the Adamkiewicz artery, which was patent on postoperative multidetector computed tomography. Univariate analysis showed no significant effect of various risk factors on the development of spinal cord injury. Conclusion: Outcome of open surgery for thoracoabdominal aortic aneurysm in our institution regarding spinal cord injury was satisfactory. The benefits of Adamkiewicz artery reconstruction remain inconclusive, and further larger studies are required to identify its validation for spinal cord protection in thoracoabdominal aortic aneurysm repair.

Objectives: Bone marrow-derived mesenchymal stromal cell (BM-MSC) delivery through cardiopulmonary bypass (CPB) can modulate CPB-induced systemic inflammation and inhibit microglial activation. The present study assessed whether BM-MSC treatment remains effective for extensive inflammatory reactions. Methods: Two-week-old piglets were randomized into control, CPB with deep hypothermic circulatory arrest (DHCA), CPB with BM-MSCs, CPB with DHCA plus 180 min extended perfusion, and extended CPB with BM-MSCs. Human BM-MSCs (1 × 107 cells/kg) were delivered via the CPB circuit during rewarming. We measured 9 porcine plasma cytokines. Brains were harvested for microglial immunohistochemistry and premotor cortex RNA-sequencing. Results: A total of 20 piglets were included (n = 4 per group). An extended CPB period increased the number of white matter microglia and plasma interferon-g (IFN-g) and TNF-a levels compared to standard CPB (P < .05). Notably, BM-MSCs normalized the extensive microglia expansion resulting from prolonged CPB (P < .001). In addition to reduced IFN-g and increased IL-10, BM-MSCs increased IL-1b and IL-8 levels, suggesting possible immunosuppressive reactions observed under inflammatory microenvironment. Gene ontology analyses in the premotor cortex post-CPB found involvement of NF-kB signalling. While there was a positive correlation between IFN-g and microglia expansion/activation, IL-10 levels were inversely correlated with the number of microglia. Consistent with immunosuppressive roles in the inflammatory environment, we found inverse correlations between IL-1b and IL-8 levels and CPB-induced microglial activation (P < .01). Conclusions: BM-MSC administration via CPB shows promise for reducing extensive inflammatory stress. Further investigation using this model will elucidate CPB-induced unique pathological events in the developing brain and mechanisms underlying the therapeutic actions of BM-MSC.

OBJECTIVES: To evaluate the feasibility, safety and quality of robotic-assisted mitral valve repair in complex versus non-complex cases during the early phase of a programme. METHODS: Since the programme launch in September 2021 until February 2024, 100 patients underwent robotic-assisted mitral valve repair. Of them, 21 patients had complex repairs, while 79 had non-complex repairs. The median age was 58 years for complex cases and 61 years for non-complex cases (P = 0.36). RESULTS: Bileaflet prolapse was significantly more prevalent in the complex group (52.4% vs 12.7%, P < 0.001). Neochord placement (61.9% vs 13.9%, P < 0.001) and commissuroplasty (28.6% vs 5.1%, P = 0.005) were more frequent in the complex group. The complex group had longer cardiopulmonary bypass times (161 vs 141 min, P < 0.001), aortic cross-clamp times (123 vs 102 min, P < 0.001) and leaflet repair times (43 vs 24 min, P < 0.001). Second pump runs were required more often for complex cases (23.8% vs 3.8%, P = 0.01). All patients left the operating room with residual mitral regurgitation of mild or less. Fewer complex patients were extubated in the operating room (42.9% vs 70.9%, P = 0.02), yet hospital stay was similar (4 vs 4 days, P = 0.56). There were no significant differences in postoperative adverse events. There were no differences in mitral regurgitation of mild or less 4 weeks post-surgery (95.2% vs 98.7%, P = 0.47). CONCLUSIONS: Complex mitral valve repair can be safely and effectively performed with robotic assistance, even in the early phase of a programme. Despite longer operative and ventilation times in the complex group, hospital stay and postoperative adverse events remained similar.

Right aortic arch in association with coarctation of the aorta and vascular ring is a rare anatomy. We present an infant with chromosome 22q11.2 deletion, who had the right aortic arch with retroesophageal aberrant left subclavian artery and left internal carotid artery. The left external carotid artery and right common carotid artery originated together from the ascending aorta as a bovine branch. The infant also had severe coarctation, which was prostaglandin dependent.