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ior to the pubic symphysis with the inferior border of the graft measuring 9.4 cm in length, should minimize injury to the ilioinguinal and iliohypogastric nerves. These dimensions allow for the longest graft while remaining relatively close to the pubic symphysis. The closer a graft is harvested to the pubic symphysis, the smaller in length the graft must be to avoid injury to the ilioinguinal and iliohypogastric nerves. BACKGROUND Approximately 10% to 20% of children are readmitted after congenital heart surgery. Very little is known about biomarkers as predictors of risk of unplanned readmission following pediatric congenital heart surgery. Novel cardiac biomarker ST2 may be associated with risk of unplanned readmission. ST2 concentrations are believed to reflect cardiovascular stress and fibrosis. Our objective was to explore the relationship between pre- and postoperative ST2 biomarker levels and risk of readmission within one year after congenital heart surgery. METHODS We prospectively enrolled pediatric patients less then 18 years of age who underwent at least one congenital heart operation at Johns Hopkins Hospital from 2010 - 2014. Plasma samples were collected immediately prior to surgery and at the end of bypass. We used Kaplan-Meier survival analysis and multivariable Cox regression models adjusting for variables used in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database mortality risk model. RESULTS In our cohort (N=145), there were 39 children with readmissions within 365 days. The median time to unplanned readmission was 54 days (IQR 10 - 153). Kaplan-Meier analysis demonstrated a significant difference across terciles of pre- and post-operative ST2 biomarker levels. After adjustment, elevated serum levels of ST2 measured preoperatively and postoperatively were associated with increased risk of readmission (hazard ratio range 2.5 to 3.7, all p less then 0.05). CONCLUSIONS Elevated levels of ST2 are significantly associated with increased risk of unplanned readmission within one-year after pediatric congenital heart surgery. selleck Novel serum biomarker ST2 can be used for risk stratification or estimating postsurgical prognosis. Percutaneous pleural maneuvers are routinely performed in the management of pleural diseases with favorable safety profile. We report a case of cerebral air embolism during a pleural lavage for the management of an empyema. This severe complication is rarely reported in the literature although it can happen after any percutaneous thoracic procedures. Asymptomatic arterial air emboli may occur in up to 5 % of percutaneous thoracic maneuvers. Diagnosis should be evoked in front of sudden neurological signs and confirmed with brain imaging. Standard treatment is based on hyperbaric oxygen therapy and can be performed safely with intra-pleural catheter. BACKGROUND Little is known about the chance of patients not experiencing complications (uneventful recovery) after aortic root replacement for aortic aneurysm. The aim of this study is to investigate the probability of uneventful recovery, identify its predictors, and address the association between the uneventful recovery and long-term survival. METHODS Patients with aortic aneurysm who underwent elective aortic root replacement between 2005 and 2018 were retrospectively reviewed (n=676). Uneventful recovery was defined as avoidance of all of the following complications during the index hospital stay mortality, any stroke, re-exploration for bleeding, respiratory failure, acute renal failure, deep sternal infection, post-cardiotomy shock, selected based on Cox proportional hazards regression for long-term survival. Permanent pacemaker implantation was included due to its clinical perspectives. Patients were divided into 4 different age groups (Group80 , P=.007). A multivariable logistic regression showed age, left ventricular ejection fraction, previous cardiac surgery, and peripheral artery disease were independent predictors of uneventful recovery. Uneventful recovery resulted in significantly better 5-year survival (Log-rank P=.039). CONCLUSIONS This study provides novel information regarding the probability of uneventful recovery while confirming low in-hospital mortality and stroke rates after elective aortic root replacement for aortic aneurysm. Importantly, uneventful recovery ensures excellent long-term survival. BACKGROUND To improve survival of patients with hypoplastic left heart syndrome (HLHS), combination therapy with bilateral pulmonary artery banding and prostaglandin E1. (PGE1)-mediated ductal patency was developed as an alternative for high-risk neonates in Japan. However, the effect of long-term PGE1 administration on the ductus arteriosus (DA) remains unclear. Synchrotron radiation-based X-ray phase-contrast tomography (XPCT) enables clear visualization of soft tissues at an approximate spatial resolution of 12.5 μm. We aimed to investigate morphological changes in DA after long-term PGE1 infusion using XPCT. METHODS Seventeen DA tissues from patients with HLHS were obtained during the Norwood procedure. The median duration of Lipo-prostaglandin E1 (Lipo-PGE1) administration was 48 (range 3-123) days. Structural analysis of DA was performed and compared with conventional histological analysis. RESULTS XPCT was successfully applied to quantitative measurements of ductal media. Significant correlation was found between the duration of Lipo-PGE1 infusion and mass density of ductal media (R0.723, P=0.001). The duration of Lipo-PGE1 administration was positively correlated with elastic fiber staining (R0.799, P less then 0.001) and negatively correlated with smooth muscle formation (R-0.83, P less then 0.001). No significant increase in intimal cushion formation was found after long-term Lipo-PGE1 administration. Expression of the DA-dominant PGE2-receptor EP4 almost disappeared in DA specimens when Lipo-PGE1 was administered over 3 days. CONCLUSIONS Disorganized elastogenesis and little intimal cushion formation after long-term Lipo-PGE1 administration suggest that DA remodeled to the elastic artery phenotype. Because EP4 was downregulated and DA exhibited elastic characteristics, the dosage of Lipo-PGE1 might be decreased after a definite administration period.
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