Background: Failure to thrive (FTT), defined as weight or height less than the lowest 2.5 percentile for age, is prevalent in up to 66% of children with congenital heart disease (CHD). Risk stratification methods to identify those who would benefit from early intervention are currently lacking. We aimed to identify a novel growth biomarker to aid clinical decision-making in children with CHD. Methods: This is a cross-sectional study of patients 2 months to 10 years of age with any CHD undergoing cardiac surgery. Preoperative weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ) were calculated and assessed for association with preoperative plasma biomarkers: growth differentiation factor 15 (GDF-15), fibroblast growth factor 21, leptin, prealbumin, and C-reactive protein (CRP). Results: Of the 238 patients included, approximately 70% of patients had WAZ/HAZ < 0 and 34% had FTT. There was a moderate correlation between GDF-15 and WAZ/HAZ. When stratified by age, the correlation of GDF-15 to WAZ and HAZ was strongest in children under 2 years of age and persisted in the setting of inflammation (CRP > 0.5 mg/dL). Diagnoses commonly associated with congestive heart failure had high proportions of FTT and median GDF-15 levels. Prealbumin was not correlated with WAZ or HAZ. Conclusions: GDF-15 represents an important growth biomarker in children with CHD, especially those under 2 years of age who have diagnoses commonly associated with CHF. Our data do not support prealbumin as a long-term growth biomarker.

As the practice of cardiothoracic surgery continues to evolve, the optimal training model represents an area of uncertainty. We sought to describe and to compare the early career experiences of cardiothoracic surgery graduates from the 3 training models. An anonymous survey with questions pertaining to an individual's demographic characteristics, training model, first employment experience, experience as junior faculty, career satisfaction, and personal reflection was sent to graduates from US cardiothoracic surgery training programs between 2012 and 2020. Respondents completed a traditional fellowship (2-3 years), a 4+3 model, or an integrated 6-year (I-6) residency. Of the 670 graduates who received the survey, there were 267 (40%) respondents. Of these, 209 (78%) respondents graduated from a traditional fellowship, 27 (10%) respondents graduated from a 4+3 pathway, and 31 (12%) respondents graduated from an I-6 residency. There was no difference in overall satisfaction, major case volume, operative autonomy, burnout, and lifestyle satisfaction between the models (P>.05). When respondents were asked about the ideal model, the 4+3 and I-6 models were favored by its graduates, regardless of the surgeons’ field of practice. Important early career outcomes were not different between graduates of traditional, 4+3, or I-6 models. Most graduates of the 4+3 and I-6 models believe these are the ideal training models, regardless of their field of practice.

Background: Transplantation using hearts obtained through donation after circulatory death (DCD) is increasing, but data on recipient renal outcomes are limited. Methods and Results: Patients at a single institution who underwent heart transplantation using organs procured through DCD or donation after brain death (DBD) from April 2016 to August 2022 were included in this retrospective cohort study. Hemodynamic measures were collected via right heart catheterization performed 1 week after transplantation. Posttransplantation renal outcomes included estimated glomerular filtration rate at 1 week, 4 weeks, and 16 weeks, and the incidence of acute kidney injury (AKI) and renal replacement therapy within 1 week. The analysis included 225 patients (55 recipients of DCD). Baseline characteristics were comparable between recipients of DCD and DBD. Renal outcomes within 1 week posttransplantation in recipients of DCD were similar to recipients of DBD, including percent change in estimated glomerular filtration rate (−37.9% [−58.6 to −6.2] versus −31.9% [−52.4 to −9.9]; P =0.91), incidence of AKI (47.3% versus 46.5%; P >0.99) and incidence of renal replacement therapy (3.6% versus 4.7%; P >0.99). Recipients of DCD with AKI within 1 week (“early AKI”) did not recover to baseline estimated glomerular filtration rate (75.8 [60.2–91.3] mL/min per 1.73 m ² ) by week 16 (59.3 [46.9–73.6] mL/min per 1.73 m ² ; P =0.002), whereas recipients without early AKI exhibited comparable estimated glomerular filtration rate to baseline by week 4 (84.5 [70.8–98.5] mL/min per 1.73 m ² ; P =0.084). Similar trends were observed in recipients of DBD. Conclusions: Recipients of DCD demonstrated similar renal outcomes compared with recipients of DBD, supporting the ongoing use of DCD transplantation. Early AKI was associated with persistent renal dysfunction for recipients of both DCD and DBD.