Haemolysis is developing prominence in the setting of supporting increasingly complex children with heart failure with a ventricular assist device. The goal of this study is to better characterise haemolysis and its implications in children supported with pulsatile ventricular assist devices.

This is a single-centre retrospective review of 44 children who were supported by Berlin Heart EXCOR between January 2006 and June 2020. Patients were divided into major haemolysers and non-major haemolysers. Major haemolysers were defined as patients with lactate dehydrogenase > 500U/L (2.5x the upper limits of normal) with either total bilirubin > 2mg/dL (with predominantly indirect hyperbilirubinemia) or anaemia out of proportion to the clinical scenario more than three days following implantation of the ventricular assist device(s). Patient demographics, ventricular assist device factors, and outcomes, including end-organ function and mortality, were compared between major haemolysers and non-major haemolysers.

Forty-four patients supported by the Berlin EXCOR were included in the analytic cohort of the study: 27 major haemolysers and 17 non-major haemolysers. Major haemolysis was more common in those supported with single-ventricle ventricular assist device (i.e., VAD in the context of functionally univentricular anatomy) compared to those with biventricular hearts, p = 0.01. There were no patients with an isolated left ventricular assist device or isolated right ventricular assist device in our analytic cohort of 44 patients. Of the 19 patients with single-ventricle ventricular assist device, 84% (16/19) were major haemolysers. Of the 25 patients with a biventricular assist device, 44% (11/25) were major haemolysers. Major haemolysers and non-major haemolysers had a body surface area of 0.28 and 0.40, respectively (p = 0.01). Overall, survival to discharge from the hospital was 66% (n = 29/44). Survival to discharge from the hospital was 52% (14/27) in major haemolysers versus 88% (15/17) in non-major haemolysers, p = 0.02. Only 3 of the 27 with major haemolysis had severe haemolysis, that is, lactate dehydrogenase > 2000 and bilirubin above 10. Non-major haemolysers had a better improvement in creatinine clearance during ventricular assist device support, p < 0.0001. (During the same era of this study, 22 patients who were supported with Berlin Heart were excluded from the analytic cohort because they did not have any recorded measurement of lactate dehydrogenase. Seventeen of these 22 patients had no clinical evidence of haemolysis. Survival to discharge from the hospital in this excluded cohort was 86% [19/22].)

Major haemolysis in patients with pulsatile ventricular assist device is more likely with single-ventricle ventricular assist device support and smaller body surface area.

Progressive ventricular remodelling in children with repaired tetralogy of Fallot may or may not result in the need for pulmonary valve replacement. We aimed to model and compare the rates of right and left ventricular adaptation over time, as assessed by cardiac MRI after surgical repair of tetralogy of Fallot, in children who did or did not require pulmonary valve replacement later in adolescence.

Single-centre, retrospective cohort study from 2000 to 2020 including patients with tetralogy of Fallot who had complete surgical repair before 24 months.

From 214 patients included in this analysis, 142 (66.3%) had pulmonary valve replacement at a median age of 12 years (interquartile range 9–15.5) during follow-up. Assessing 323 cardiac MRI studies from 201 patients commencing from a median age of 9.4 years (interquartile range 5.9–12.3), the group that required pulmonary valve replacement later during the follow-up had a steeper time-related right ventricular dilation trajectory than non-pulmonary valve replacement patients: the increment in right ventricular end-diastolic volume index was 19.4 versus 2.8 ml/m2/log2year, P < 0.001; also, right ventricular end-systolic volume index incremented more quickly, at 11.9 versus 0.8 ml/m2/log2year, P < 0.001. Left ventricular end-diastolic volume index increased more quickly in patients who eventually had pulmonary valve replacement, at 7.2 versus 1.5 ml/m2/log2year, P = 0.005; the same occurred for indexed left ventricular end-systolic volume at 3.2 versus –0.4 ml/m2/log2year, P = 0.001.

Early right and left ventricular dilation over time are identifiable by cardiac MRI in patients destined to require pulmonary valve replacement following tetralogy of Fallot repair.

B lines in lung ultrasound are useful to diagnose heart failure in adults. This study was to done to correlate lung ultrasound score with heart failure severity in CHD.

Fifty infants with left to right shunt underwent Ross scoring, measurement of NT pro BNP and lung ultrasound. Lung was divided into 14 zones (7 on each side); each zone was scored as: No B lines = 0, less than 3 B lines = 1, 3-7 B lines = 2, > 7 /or confluent B lines = 3. Total score was calculated by adding all scores. A modified ultrasound score was calculated by excluding scores of 1. Relationship between ultrasound scores and heart failure was assessed. Receiver operator curve (ROC) was generated to find a cut-off of ultrasound score to detect moderate or severe heart failure.

No correlation was found between either total or modified lung ultrasound score with the modified Ross score or NT pro BNP. A cut-off of total lung ultrasound score of 11 gave an accuracy of 68% with area under the curve (AUC) of 0.64 to detect moderate or severe heart failure.

Utility of lung ultrasound in detecting severity of heart failure in infants with left to right shunts is limited at present due to its low accuracy and lack of standardised method of scoring.

Pulmonary regurgitation leading to right ventricular enlargement may occur after repaired tetralogy of Fallot (rTOF) or balloon dilation for pulmonary valve stenosis. Cardiac magnetic resonance imaging (CMR) guidelines to identify the timing of valve replacement in rTOF are not necessarily applicable to isolated pulmonary regurgitation. This study aims to compare deformation parameters of isolated pulmonary regurgitation and rTOF at comparable right ventricular volume loads.

Adopting a quantitative retrospective analytic framework, CMR was performed in 44 patients (0–30 years), 22 in each of the isolated pulmonary regurgitation and rTOF study arms, matched for age (±12 months), and Right ventricular end-diastolic volume z-score (±1). Right ventricular longitudinal strain/strain rate and circumferential strain/strain rate were measured. Comparisons between groups were analysed using two-tailed T-tests and one-way ANOVA.

Both groups showed predominance of longitudinal over circumferential strain. Circumferential strain was significantly greater in rTOF compared to isolated pulmonary regurgitation (–26.5% versus –22.3%, p < 0.05). Longitudinal strain did not differ between groups. The longitudinal:circumferential strain ratio was significantly lower in rTOF compared to isolated pulmonary regurgitation (1.24 versus 1.53, p = 0.05). Circumferential and longitudinal strain rates did not differ between groups.

The right ventricles in rTOF demonstrate greater reliance on circumferential strain in response to increased volumes. The decrease in longitudinal:circumferential strain ratio suggests rTOF right ventricles display a greater adaptive response to the volume load than isolated pulmonary regurgitation, highlighting the importance of the relative contributions of both circumferential and longitudinal strain in order to understand the mechanisms of right ventricular dysfunction in pulmonary regurgitation.

Reports of paediatric cardiac neurodevelopmental programmes are predominately limited to high-volume surgical centres. Regional characterisation of neurodevelopmental care practices across multiple centres both with and without cardiac surgery programmes has not yet been described.

Assess cardiac neurodevelopmental infrastructure and approach across New England to describe regional support for children with CHD.

A 16-item survey assessing inpatient and outpatient neurodevelopmental care practices was sent electronically via REDCap to all member institutions of the New England Congenital Cardiology Association Health Disparities Working Group. Centres were characterised by surgical capability, annual volume, and academic affiliation. Descriptive statistics and Fisher’s exact test were used for comparisons.

The survey response rate was 90% (9/10). Participating centres included non-surgical academic centres (55%), small surgical centres (22%) and medium-large surgical centres (22%). Surgical centres typically refer their patients to internal neurodevelopmental services (100%) and rely on automatic referral processes (100%). Non-surgical centres predominately refer to the institution where cardiac surgery was performed (80%) compared to engaging local teams (20%) and depend on family or physician-initiated referral (100%) to schedule neurodevelopmental services. While none of the non-surgical centres surveyed have cardiac-specific neurodevelopmental programmes, all have other developmental programmes that accommodate children with CHD.

Varying neurodevelopmental infrastructure and resources are reported across New England. Academic, non-surgical centres may have infrastructure for neurodevelopmental follow-up despite not having cardiac neurodevelopmental programmes. Collaboration between surgical and non-surgical cardiac centres in New England may be leveraged to promote neurodevelopmental care closer to home.

Sepsis, a life-threatening organ dysfunction resulting from a dysregulated host response to infections, poses a critical threat. Cardiac surgery itself induces a robust inflammatory response, further exacerbated by cardiopulmonary bypass, causing notable clinical and physiological changes. Identifying sepsis early in the post-operative period with elevated septic markers becomes challenging, with delayed antibiotic intervention ultimately posing a fatal risk for the patient.

We performed a prospective observational cross-sectional study aimed at identifying sepsis markers that include total leucocyte count, absolute neutrophil count, platelet count, serum albumin, chest X-ray, blood, urine, and tracheal cultures, procalcitonin, c-reactive protein, serum lactate >2.5 mmol/l along with clinical parameters (fever, hypotension, tachycardia) on post-operative days 1, 3, 5, and 10 in paediatric patients undergoing cardiac surgery with prolonged cardiopulmonary bypass time >100 min.

Total leucocyte count, absolute neutrophil count, and platelet counts were not significant enough to detect early sepsis, especially in patients with prolonged cardiopulmonary bypass time. Chest X-ray was significant from post-operative day 3 onwards. Procalcitonin was significant from day 5, and C-reactive protein was significant only from day 10. Among the clinical parameters, fever, hypotension, tachycardia, and elevated lactate levels were significant from post-operative day 1 in the patients developing sepsis.

Neonates and infants faced a higher sepsis risk than older children. Longer cardiopulmonary bypass and aortic clamp times correlated with increased sepsis likelihood. Clinical factors outweighed laboratory indicators for early sepsis detection post-cardiac surgery, prompting prompt investigation and intervention.

We compared the results of conventional electroanatomic mapping and high-density mapping in ablations of the right ventricular outflow tract.

Between 2014 and 2024, a total of 92 patients underwent ablation using an electroanatomic mapping system. A contact force radiofrequency ablation catheter was used in all patients, except for two who underwent cryoablation.

Our study comprised two groups, with a total of 92 patients. Among them, 45 patients underwent conventional three-dimensional mapping, while 47 patients underwent high-density three-dimensional mapping. In both groups, there were three patients with nonsustained ventricular tachycardia and two patients with sustained ventricular tachycardia, and there was no statistically significant difference in the frequency of ventricular premature contractions between the two groups. There were four patients with systolic dysfunction in the high-density mapping group and four in the conventional mapping group. In the high-density mapping group, the procedure time was significantly shorter. There was a notable difference regarding the reduced fluoroscopy time. The total lesion time and number were also significantly lower in the high-density mapping group. The earliest activation time was significantly longer in this group. The procedure’s success rate was 97.9% for the high-density mapping group and 93.4% for the conventional mapping group. Successful ablation was performed on one ventricular extrasystole in the parahisian localisation in each group, while a cooled type radiofrequency catheter was used for all other cases.

In children with right ventricular outflow tract arrhythmias, high-density mapping can be used with high success rates and safety.

The persistence of palpitations in some patients after supraventricular tachycardia ablation is a common challenge despite high procedural success rates. Establishing a correlation between symptoms and tachycardia is especially crucial for adolescent patients, who face challenges in perceiving and articulating their symptoms. This study aimed to evaluate the significance and efficacy of external event recorders in detecting symptom-arrhythmia correlation in paediatric patients experiencing palpitations following successful supraventricular tachycardia ablation.

Among the 1682 patients who underwent successful supraventricular tachycardia ablation at our center between 2013 and 2023, the study included those who met the following criteria: 1) diagnosed with atrioventricular nodal reentrant tachycardia, concealed accessory pathway, or focal atrial tachycardia (excluding substrates identifiable on surface electrocardiogram such as Wolff-Parkinson-White and Mahaim type preexcitations), 2) without CHD, 3) aged over 10 years (as this age is considered sufficient for reliable symptom reporting), and 4) presenting with palpitations post-ablation, with no supraventricular tachycardia detected on electrocardiogram or 24-hour Holter monitoring. Patient data were retrospectively reviewed from medical records.

Among a total of 104 patients reporting palpitations (15%), event recording data of 73 patients were available. Supraventricular tachycardia was documented in eight cases, whereas sinus tachycardia was detected in nine patients. Symptom-arrhythmia correlation was achieved in 23% of patients, nearly half of whom had supraventricular tachycardia recurrence. Patients reporting palpitations with recurrent supraventricular tachycardia episodes were analysed according to diagnostic subgroups. The recurrence rate in patients with palpitations was higher in the focal atrial tachycardia group compared to the others (33%).

Despite successful ablation procedures, palpitations continue to pose a significant concern. To precisely explore the actual symptom-rhythm correlation, we advocate safe and effective utilisation of external event recorders in paediatric patients, particularly those with sporadic symptoms, as opposed to relying solely on electrocardiogram and Holter monitoring.

Individuals with 22q11 deletion syndrome have a mutation in the TBX1 gene. This is associated with reduced left pulmonary artery/right pulmonary artery ratio in animal models and in humans with structurally normal hearts.

A retrospective analysis was undertaken of patients who underwent surgical repair of Tetralogy of Fallot, truncus arteriosus, and interrupted aortic arch between 01/2007 and 12/2022. The left pulmonary artery/right pulmonary artery ratio on initial and most recent echocardiogram and initial and subsequent intervention on the left pulmonary artery were compared between patients with and without 22q11 deletion.

There were 134 included patients; 19 patients had the deletion (22q11 positive), and 115 patients did not have the deletion (22q11 negative). Tetralogy of Fallot was present in 8/19 and 101/115 patients, truncus arteriosus in 7/19 and 7/115 patients, and interrupted aortic arch in 4/19 and 7/115 patients. Patients who were 22q11 positive had a reduced left pulmonary artery/right pulmonary artery ratio on both the initial echocardiogram [0.88 (interquartile range 0.71, 0.97) versus 1.02 (interquartile range 0.92, 1.12); p < 0.001] and most recent echocardiogram [0.66 (interquartile range 0.62, 0.91) versus 1.01 (interquartile range 0.89, 1.16); p < 0.001] and were more likely to have intervention on the left pulmonary artery at their initial surgery (36% versus 8.7%; p = 0.003).

Patients who were 22q11 positive trended towards reduced left pulmonary artery/right pulmonary artery ratios and need for early surgical intervention on the left pulmonary artery in comparison to patients without 22q11 deletion negative patients.

To highlight veno-venous collaterals and portosystemic shunts as possible causes of cyanosis requiring evaluation or treatment below the diaphragm in patients with single-ventricle physiology during staged palliation.

Cyanosis can complicate staged single-ventricle palliation and is often evaluated with imaging isolated to the thorax. As a result, lesions below the diaphragm, such as veno-venous collaterals and portosystemic shunts, may be missed. Identification is important since these lesions can be treated via transcatheter techniques.

This study is a retrospective, single-centre case series of six patients.

Two patients following stage 2 palliation had multiple small veno-venous collaterals connecting to a reconstituted azygos with retrograde flow to below the diaphragm. Accessing veno-venous collaterals closer to their entry points below the diaphragm was more optimal for occlusion. Two patients following stage 3 palliation had veno-venous collaterals originating below the diaphragm and connecting to the pulmonary veins. Both patients required infrarenal inferior vena cava contrast injection to identify the veno-venous collateral. The final two patients had heterotaxy with either stage 2 or 3 palliation and were found to have bilateral pulmonary arteriovenous malformations secondary to a portosystemic shunt diverting hepatic factor away from the lungs. All patients had successful device closure of their veno-venous collaterals or portosystemic shunts.

The six patients discussed demonstrate the importance of evaluating below the diaphragm in single-ventricle physiology patients presenting with cyanosis.

The impact of CHD on safe driving for adolescents is currently unknown. A prospective, qualitative descriptive study was conducted among adolescents with CHD to describe perceived barriers, facilitators, and impacts of CHD on safe, independent driving among adolescents.

Twenty-eight adolescents aged 15–19 years with CHD participated in virtual, semi-structured interviews in 2023. Adolescent interview data were analysed with conventional content analysis refined by Theoretical Domains Framework in NVivo software.

Mean participant age was 16.4 ± 0.23 years (57% male). Single ventricle physiology (25%) and septal defects (32%) were prevalent diagnoses among the study population. Most participants (92%) did not have driving restrictions.

Driving as a normal rite of passage for adolescents with CHD; and confident—but curious—about the impacts of CHD on driving. Adolescents felt confident that driving is not impacted by CHD. They were curious about the likelihood of cardiovascular emergencies and related symptoms while driving. Perceived barriers and facilitators to safe, independent driving were like what has been described in published literature among adolescents without CHD.

These findings celebrate the normalcy of driving during adolescence and reveal curiosities about the impacts of stress, anxiety, fatigue, and risks of heart attack and stroke on driving. Adolescents may look to CHD healthcare providers to help them learn about driving. These findings may inform the development of tools to facilitate meaningful conversations with adolescents regarding driving safety as part of the transition to adult CHD care.

To determine the epidemiologic change in Kawasaki disease during the post-acute phase of the coronavirus disease 2019 pandemic compared with the pre- and acute phases.

A follow-up epidemiological study was conducted using data obtained from hospitalised patients with Kawasaki disease in Shiga Prefecture, Japan. The study period was divided into three phases: pre-pandemic (January 2015 to March 2020), acute pandemic (April 2020 to December 2020), and post-acute pandemic (January 2021 to December 2022). The incidence of Kawasaki disease was compared among these phases, focusing on monthly variation, patient age, and regional population density.

A total of 1,598 patients with Kawasaki disease were analysed. The per cent change in Kawasaki disease incidence from the pre-pandemic phase was −33.8% and −27.9% in the acute and post-acute phases, respectively. Monthly variation during the post-acute phase dramatically differed from that observed in the pre- and acute phases, with the highest incidence in August and the lowest in April. The Kawasaki disease reduction was larger in patients ≥4 years old during the post-acute phase. An association between population density and reduction in Kawasaki disease incidence was no longer observed during the post-acute phase, contrary to the result during the acute phase.

The reduction in Kawasaki disease incidence in Shiga Prefecture remained in the post-acute phase of the coronavirus disease 2019 pandemic, although seasonal variation dramatically differed from the traditional pattern. Infection prevention measures by individuals might reduce Kawasaki disease development in the children ≥4 years old.

Pulmonary artery capacitance is a relatively novel measurement associated with adverse outcomes in pulmonary arterial hypertension. We sought to determine if preoperative indexed pulmonary artery capacitance was related to outcomes in paediatric heart transplant recipients, describe the changes in indexed pulmonary artery capacitance after transplantation, and compare its discriminatory ability to predict outcomes as compared to conventional predictors.

This was a retrospective study of paediatric patients who underwent heart transplant at our centre from July 2014 to May 2022. Variables from preoperative and postoperative clinical, catheterisation, and echo evaluations were recorded. The primary composite outcome measure included postoperative mortality, postoperative length of stay in the top quartile, and/or evidence of end organ dysfunction.

Of the 23 patients included in the analysis, 11 met the composite outcome. There was no statistical difference between indexed pulmonary artery capacitance values in patients who met the composite outcome [1.8 ml/mmHg/m2 (interquartile 0.8, 2.4)] and those who did not [1.4 (interquartile 0.9, 1.7)], p = 0.17. There were no significant signs of post-operative right heart failure in either group. There was no significant difference between pre-transplant and post-transplant indexed pulmonary artery capacitance or indexed pulmonary vascular resistance.

Preoperative pulmonary artery capacitance was not associated with our composite outcome in paediatric heart transplant recipients. It did not appear to be additive to pulmonary vascular resistance in paediatric heart transplant patients. Pulmonary vascular disease did not appear to drive outcomes in this group.

Transcatheter pulmonary valve implantation has emerged as a minimally invasive and preferred therapeutic option for patients with dysfunction of previously repaired right ventricular outflow tracts. The Myval™ Octacor valve is a new device designed for this purpose, though limited reports exist regarding its use in the pulmonary position.

To report the immediate and short-term outcomes of percutaneous pulmonary valve implantation using the Myval™ Octacor valve in patients with severe right ventricular–pulmonary artery conduit or pulmonary valve bioprosthesis dysfunction.

This was a single-centre retrospective review of data obtained from case files.

The Myval™ Octacor valve was used in ten patients with a mean age of 34.5 ± 7.4 years. The median procedure duration and fluoroscopy time were 146 minutes and 30.5 minutes, respectively. The median Z-score for valves used was −0.5. The median right ventricular systolic pressure decreased from 68.5 mmHg pre-procedure to 33 mmHg post-procedure. The median peak instantaneous gradient across the right ventricular outflow tract or conduit decreased from 30 mmHg to 6.5 mmHg. There were no reported incidences of frame fracture, conduit rupture, device embolisation, or endocarditis.

This is the first UK experience of using the new-generation Myval™ Octacor valve in percutaneous pulmonary valve implantation. The results demonstrate the valve’s safety and clinical efficacy, with favourable outcomes in terms of procedural success, haemodynamic improvement, and echocardiographic findings.

Coronary artery abnormalities in children that require bypass grafting are infrequent but represent a well-recognised entity with a broad spectrum of indications beyond Kawasaki disease. Although myocardial revascularisation in children is uncommon, studies have shown that it can yield favourable short- and long-term outcomes, allowing affected children to regain health and grow up to live normal lives.

Myocardial revascularisation in children is an extremely rare intervention in Western countries, accounting for less than 1% of all paediatric cardiac surgeries in this region. It is a highly technically demanding procedure that opens a new arena in cardiac surgery, for which cardiovascular surgeons need to be trained to achieve outcomes as good as those shown in the literature.

We present the experience of paediatric coronary artery bypass grafting in a middle-income country, with a wide range of indications.

A retrospective descriptive study was conducted on paediatric patients (under 18 years of age) who underwent coronary artery bypass grafting between 2004 and 2023 at a cardiovascular centre in Bogotá, Colombia. Data were collected from electronic medical records, including demographics, preoperative diagnoses, surgical details, and outcomes. Follow-up included clinical assessment and imaging with echocardiography. Ethical approval was obtained, and confidentiality was ensured.

Nine paediatric patients (ages 6–17) underwent coronary artery bypass grafting between 2004 and 2023. Kawasaki disease was the most common indication, but there are other aetiologies, including post-arterial switch coronary occlusion, anomalous origin of the LCA from the pulmonary artery, anomalous origin of coronary arteries from the aorta, Takayasu disease, and iatrogenic injury. The internal mammary artery was used in most cases, with successful completion of the planned revascularisation in all patients. There were no perioperative deaths or reinterventions. At a mean follow-up of 5.5 years, all patients showed clinical and biventricular improvement, and all grafts evaluated showed graft patency.

Paediatric coronary artery bypass grafting is a safe and effective treatment for selected congenital and acquired coronary pathologies, even in complex cases. Outcomes are optimised with the use of internal mammary arteries and a multidisciplinary heart team approach. In middle-income settings, favourable short- and mid-term results can be achieved despite follow-up challenges. Paediatric coronary artery bypass grafting should be considered a key component of congenital cardiac surgery training.

To examine the added value of an elevated calculated peak right ventricular outflow tract pressure gradient as a surrogate for infective endocarditis diagnosis.

A cohort study included patients admitted between 2003 and 2020 at a tertiary children’s medical centre. Patients with surgically inserted exogenous right ventricular outflow tract conduits and infective endocarditis were included. Infective endocarditis was diagnosed using the revised Duke criteria (2023). Controls had right ventricular outflow tract conduits and febrile illness from other causes. Clinical, laboratory, and echocardiographic findings, including calculated peak right ventricular outflow tract pressure gradient, were collected.

Among 26 febrile episodes (11 with infective endocarditis, 15 controls), the infective endocarditis group had a higher peak right ventricular outflow tract pressure gradient during acute illness (70 vs. 23 mmHg, p < 0.05). On admission, 18% of infective endocarditis patients had a definite diagnosis by Duke’s criteria, 45% had a probable diagnosis, and 36% lacked confirmation. Including peak right ventricular outflow tract gradient as a major criterion would yield a 90% diagnosis rate upon admission (45% definite, 45% possible).

Increased right ventricular outflow tract pressure gradient in febrile patients with exogenous conduit in the right ventricular outflow tract is a potential marker for infective endocarditis. Including this gradient as a major Duke criterion enables earlier and more definitive diagnosis in debatable cases.

“Frailty” is associated with worse outcomes in adult cardiology. There is limited data on the associations between frailty and outcomes in paediatric cardiology. We aimed to define the prevalence of frailty and identify associations between frailty and neurodevelopmental and quality-of-life outcomes in high-risk paediatric cardiac populations.

This cross-sectional study included patients 4–18 years seen in a neurodevelopmental programme between 6/2017 and 11/2022. Demographic and clinical data were obtained from medical records. As part of the routine care, physical therapy assessment and neurocognitive, psychosocial, adaptive functioning, and quality-of-life surveys were administered. Social determinants of health were assessed by insurance status and Childhood Opportunity Index. Frailty was defined as the abnormality in 3 of 5 categories: body composition, weakness, slowness, physical activity, and exhaustion. Chi-Square, Student t, and Wilcoxon Rank Sum tests were used to assess differences between frail and non-frail groups.

Of the 270 patients, 101 (37%) met the frailty criteria. Frailty was not associated with social determinants of health, cardiac diagnosis, genetic syndrome, number of cardiac surgeries, or history of clinical complications. Frail patients were more likely to be older (p = 0.004) and have neurocognitive (p = 0.024), emotional (p = 0.003), social (p < 0.001), motor (p < 0.001), and adaptive dysfunction (p < 0.001) and lower quality of life (p = 0.029).

Frailty is common in school-aged patients with cardiac disease and is associated with adverse neurocognitive, psychosocial, motor, and adaptive outcomes and worse quality of life. Risk stratification for frailty may be a critical evaluation and screening element of high-risk cardiac patients in neurodevelopmental programmes.

Integrating psychosocial health services into paediatric surgical specialty care is essential for addressing behavioural and psychological aspects of illness and reducing healthcare disparities. This is crucial for patients facing CHD, who are at higher risk for depression, anxiety, and attention-deficit/hyperactivity disorder, which is significantly influenced by their caregivers’ mental well-being.

The Pediatric Psychosocial Preventative Health Model framework was utilised by a psychosocial team to assess biopsychosocial needs in CHD patients during their first cardiac surgery evaluations. Patient and family needs were categorised into universal, targeted, and clinical tiers, allowing for responsive interdisciplinary services. Screening tools such as the Psychosocial Assessment Tool, Pediatric Quality of Life Inventory, and Depression, Anxiety, and Stress Scales were used during initial consultations to guide appropriate interventions and referrals.

Universal-tier patients received comprehensive support focused on preventive measures, resource access, and education to promote resilience. Targeted-tier care involved intensive, collaborative efforts, providing specialized psychological evaluations, and one-on-one time with experts. Clinical-tier families required specialised, intensive interventions such as advanced cognitive behavioural therapy and medication management. The Pediatric Psychosocial Preventative Health Model framework and psychosocial team workflow allow for individualised management strategies, ensuring that each family received timely and appropriate interventions based on their unique needs.

Integrating psychosocial services into initial surgical evaluations is critical for addressing CHD patients’ psychological and social needs, promoting an interdisciplinary approach that enhances overall family functioning and well-being.