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The Extracorporeal Life Support Organization (ELSO) maintains the world’s largest extracorporeal membrane oxygenation (ECMO) registry by volume, center participation, and international scope. This 2022 ELSO Registry Report describes the program characteristics of ECMO centers, processes of ECMO care, and reported outcomes. Neonates (0–28 days), children (29 days–17 years), and adults (≥18 years) supported with ECMO from 2009 through 2022 and reported to the ELSO Registry were included. This report describes adjunctive therapies, support modes, treatments, complications, and survival outcomes. Data are presented descriptively as counts and percent or median and interquartile range (IQR) by year, group, or level. Missing values were excluded before calculating descriptive statistics. Complications are reported per 1,000 ECMO hours. From 2009 to 2022, 154,568 ECMO runs were entered into the ELSO Registry. Seven hundred and eighty centers submitted data during this time (557 in 2022). Since 2009, the median annual number of adult ECMO runs per center per year increased from 4 to 15, whereas for pediatric and neonatal runs, the rate decreased from 12 to 7. Over 50% of patients were transferred to the reporting ECMO center; 20% of these patients were transported with ECMO. The use of prone positioning before respiratory ECMO increased from 15% (2019) to 44% (2021) for adults during the coronavirus disease-2019 (COVID-19) pandemic. Survival to hospital discharge was greatest at 68.5% for neonatal respiratory support and lowest at 29.5% for ECPR delivered to adults. By 2022, the Registry had enrolled its 200,000th ECMO patient and 100,000th patient discharged alive. Since its inception, the ELSO Registry has helped centers measure and compare outcomes across its member centers and strategies of care. Continued growth and development of the Registry will aim to bolster its utility to patients and centers.

Current processes to manufacture nanotubes at commercial scales are unfortunately imperfect and commonly generate undesirable byproducts. After manufacturing, purification is necessary and is a rate and cost determining step in advancing the development of commercial products based on nanotubes. Boron nitride nanotubes (BNNTs) produced without metal catalysts from high-temperature processes are known to contain a significant amount (e.g., 50 wt %) of various boron derivatives. Herein we report a simple yet efficient and scalable process to purify these types of BNNT materials at commercial scales, from a few grams to hundreds of grams, at purity over 85 wt % in a single step. The process relies on a vertically mounted flow tube reactor and scrubber system that can be operated under pure or diluted chlorine gas flow at temperatures up to 1100 °C. The main chemical reactions driving the purification are the conversion of boron and BN derivatives into BCl3and HCl, which are removed as gaseous species, while pristine BNNTs are left behind. The preferential etching of impurities over pristine BNNTs shows the extreme chemical resistance of BNNTs in this harsh environment and opens up new applications for this nanomaterial. The process has been examined at various temperatures, up to 1050 °C, and the resulting materials display improved BNNT purity and quality across a range of imaging and spectroscopic assessments. The recommended temperature to optimize quality with yield is 950 °C, although higher quality material is obtained at a higher temperature.

Suburbs can provide suitable habitat for birds because there are more "edges" and more intermediate disturbance that works to increase the diversity of bird populations. Native plants support significantly greater bird abundance, diversity, and species richness as compared with exotic plants or turf grass. [Extracted from the article]

We recently demonstrated scalable manufacturing of boron nitride nanotubes (BNNTs) directly from hexagonal BN (hBN) powder by using induction thermal plasma, with a high-yield rate approaching 20 g/h. The main finding was that the presence of hydrogen is crucial for the high-yield growth of BNNTs. Here we investigate the detailed role of hydrogen by numerical modeling and in situoptical emission spectroscopy (OES) and reveal that both the thermofluidic fields and chemical pathways are significantly altered by hydrogen in favor of rapid growth of BNNTs. The numerical simulation indicated improved particle heating and quenching rates (∼105K/s) due to the high thermal conductivity of hydrogen over the temperature range of 3500–4000 K. These are crucial for the complete vaporization of the hBN feedstock and rapid formation of nanosized B droplets for the subsequent BNNT growth. Hydrogen is also found to extend the active BNNT growth zone toward the reactor downstream, maintaining the gas temperature above the B solidification limit (∼2300 K) by releasing the recombination heat of H atoms, which starts at 3800 K. The OES study revealed that H radicals also stabilize B or N radicals from dissociation of the feedstock as BH and NH radicals while suppressing the formation of N2or N2+species. Our density functional theory calculations showed that such radicals can provide faster chemical pathways for the formation of BN compared with relatively inert N2.

Boron nitride nanotubes (BNNTs) exhibit a range of properties that are as compelling as those of carbon nanotubes (CNTs); however, very low production volumes have prevented the science and technology of BNNTs from evolving at even a fraction of the pace of CNTs. Here we report the high-yield production of small-diameter BNNTs from pure hexagonal boron nitride powder in an induction thermal plasma process. Few-walled, highly crystalline small-diameter BNNTs (∼5 nm) are produced exclusively and at an unprecedentedly high rate approaching 20 g/h, without the need for metal catalysts. An exceptionally high cooling rate (∼105K/s) in the induction plasma provides a strong driving force for the abundant nucleation of small-sized B droplets, which are known as effective precursors for small-diameter BNNTs. It is also found that the addition of hydrogen to the reactant gases is crucial for achieving such high-quality, high-yield growth of BNNTs. In the plasma process, hydrogen inhibits the formation of N2from N radicals and promotes the creation of B–N–H intermediate species, which provide faster chemical pathways to the re-formation of a h-BN-like phase in comparison to nitridation from N2. We also demonstrate the fabrication of macroscopic BNNT assemblies such as yarns, sheets, buckypapers, and transparent thin films at large scales. These findings represent a seminal milestone toward the exploitation of BNNTs in real-world applications.

Our goal was to develop a less invasive total cavopulmonary connection (TCPC) sheep model for testing total cavopulmonary assist (CPA) devices. Thirteen sheep underwent a right fourth intercostal lateral thoracotomy. In series I (n = 6), a polytetrafluoroethylene (PTFE) extracardiac conduit (ECC) was connected to inferior vena cava (IVC) and superior vena cava (SVC) by end-to-side anastomosis. The SVCIVC remained connected to right atrium (RA). A PTFE graft bridged ECC to right pulmonary artery (RPA). Clamps between SVCIVC anastomoses and RA diverted total venous blood to pulmonary circulation. In series II (n = 7), temporary bypasses between SVCIVC and RA allowed SVCIVC to be cut off from RA for better RPA exposure. The ECC-SVCIVC were end-end anastomosed and ECC-RPA side-side anastomosed for total SVCIVC to pulmonary artery (PA) conversion. In each series, one sheep died of bleeding. In five sheep in series I and six sheep in series II, the TCPC model was successfully created with significantly increased central venous pressure and significantly decreased PA pressurearterial blood pressure. Our acute TCPC sheep model has a less traumatic right thoracotomy with no cardiopulmonary bypass and less blood loss with no blood transfusion, facilitating future long-term CPA device evaluation.

Congenital diaphragmatic hernia (CDH) presenting beyond the neonatal period is commonly perceived to be rare. With reported frequencies of 2.6% to 20% of all CDH, it may be an overlooked cause of mortality. Variable symptomatology makes its diagnosis challenging. We report the sudden death of a 3-month-old patient shortly after hospital discharge following congenital heart surgery. Autopsy findings associated the patient’s demise with migrated abdominal contents in the chest through a Bochdalek hernia defect. No indications of CDH existed before hospital discharge. Relevant issues pertaining to congenital heart disease, CDH, and importance of autopsy in this context are discussed.

Currently, almost five million Americans and 23 million people worldwide are living with congestive heart failure (CHF), with 2 million new cases diagnosed each year.  The etiology is mostly ischemic, idiopathic, or viral, and more than $36 billion is spent each year on the care of congestive heart failure patients. Treatment of advanced CHF takes three forms:  medical therapy, surgical therapy and cardiac replacement.  Medical therapy, including inotropes and vasodilators, relieves symptoms by reducing cardiac work and increasing myocardial contractility.  This has helped improve quality of life, but mortality remains unaffected.  Surgical therapy, including revascularization, ventricular restoration and valve replacement/repair, relieves symptoms and improves function, but in most cases does not stop the underlying disease process from progressing.  When conventional medical or surgical therapies are exhausted, cardiac assist or replacement, including ventricular assist device (VAD), heart transplant or a total artificial heart (TAH) may become the only therapeutic options.  This article will not discuss the use of extracorporeal membrane oxygenation for cardiac support that is described in an additional article in this issue of Organogenesis.

Objectives. To evaluate the incidence of atrial tachy‐arrhythmia (AT) recurrence following conversion from right atrial‐pulmonary artery (RA‐PA) Fontan to total cavopulmonary connection (TCPC) in adults.

The objective of this study was to provide a descriptive comparison of a single institution's experience with preferential Glenn shunts performed with and without cardiopulmonary bypass.

Each year in the United States, more than 4.4 million patients with chest pain (DRG 143)1present to emergency departments. Many of these admissions do not have documented justification to support an acute inpatient admission. Two Medicare quality improvement organizations identified this as a common theme, and special projects were designed and implemented to reduce the incidence of inappropriate hospital admissions for chest pain in their states (Florida and Arizona). One commonality to both intervention projects was use of the case management protocol (CMP).

The Fontan operation has gone through multiple incarnations since Fontan and Baudet's initial description in 1971. Through the medical dossier of a patient with a single ventricle, we plot the history of medical, surgical, and percutaneous interventions over the past 40?years, specifically focusing on the Fontan procedure, its development, indications, sequelae, and complications. Cardiac computed tomography with angiography is highlighted as a noninvasive imaging tool for the evaluation of the complex Fontan circulation.

The thymus begins involution in childhood and historically it was thought to be nonfunctional by adulthood, thus presenting no contraindication to the routine practice of thymectomy during cardiothoracic surgery. More recent data suggest, however, that the thymus remains active into adulthood and is responsible for the low-level production of normal T cells. We hypothesize, therefore, that incidental thymectomy during cardiothoracic surgery in infancy causes long-term changes in the cellular immune system. To investigate this hypothesis, we quantified peripheral T-cell subsets and T-cell recombination excision circles in children with congenital heart disease to measure the impact of cardiothoracic surgical procedures and thymectomy performed during a period of immunologic development. We found that cardiothoracic surgical procedures, especially if they include thymectomy, impair T-cell production and produce long-term decreases in total lymphocyte count and CD4+and CD8+T-cell subsets, suggesting that long-term maintenance of lymphocyte populations is disturbed.

The thymus begins involution in childhood and historically it was thought to be nonfunctional by adulthood, thus presenting no contraindication to the routine practice of thymectomy during cardiothoracic surgery. More recent data suggest, however, that the thymus remains active into adulthood and is responsible for the low-level production of normal T cells. We hypothesize, therefore, that incidental thymectomy during cardiothoracic surgery in infancy causes long-term changes in the cellular immune system. To investigate this hypothesis, we quantified peripheral T-cell subsets and T-cell recombination excision circles in children with congenital heart disease to measure the impact of cardiothoracic surgical procedures and thymectomy performed during a period of immunologic development. We found that cardiothoracic surgical procedures, especially if they include thymectomy, impair T-cell production and produce long-term decreases in total lymphocyte count and CD4and CD8T-cell subsets, suggesting that long-term maintenance of lymphocyte populations is disturbed.

Cardiac allografts with coronary artery disease may permit a selective expansion of the donor pool. Twenty-two recipients who received donor hearts with mild to moderate coronary artery disease on angiography were reviewed. All donor organs had preserved left ventricle function on echocardiogram.

From January 1995 to April 2001, 71 patients with cardiogenic shock using the BVS 5000 were treated or accepted in transfer. Of the 24 transplanted, nine had dilated cardiomyopathy, ischemic cardiomyopathy, acute myocardial infarction, giant cell myocarditis and previous Fontan procedure (group I, n = 13). The others had postcardiotomy shock (group II, n = 11); seven were transferred to our center after device implantation. Age ranged from 8 to 67 years. Ten (77%) patients in group I were implanted without cardiopulmonary bypass. The mean duration of support was 6.7 (2–24) d. Twelve patients were extubated before transplantation and 13 (five in group I, eight in group II) received nonstandard donor organs. Survival to discharge and 1‐year actuarial survival was 85 and 77% for group I and 73 and 64% for group II, respectively. Patients with post‐implant serum bilirubin levels > 10 mg/dL had a tendency to expire from multiple systemic organ failure. Patients not ventilator‐dependent at the time of transplant had the best outcomes. Short‐term bridge to transplantation using the BVS 5000 is feasible in selected patients. Caution is recommended when directing such patients to transplant if they need ventilator support and have high serum bilirubin levels.

Older age, prior transplantation, pulmonary hypertension, and mechanical support are commonly seen in current potential cardiac transplant recipients. Transplants in 436 consecutive adult patients from 1994 to 1999 were reviewed. There were 251 using standard donors in 243 patients (age range 18–69 years). To emphasize recipient risk, 185 patients who received a nonstandard donor were excluded from analysis. The indications for transplant were ischemic heart disease (n = 123, 47%), dilated cardiomyopathy (n = 82, 32%), and others (n = 56, 21%). One hundred and forty‐nine (57%) recipients were listed as status I; 5 and 6% were supported with an intra‐aortic balloon and an assist device, respectively. The 30‐d survival and survival to discharge were 94.7 and 92.7%, respectively; 1‐year survival was 89.1%. Causes of early death were graft failure (n = 6), infection (n = 4), stroke (n = 4), multiorgan failure (n = 3) and rejection (n = 2). Predictors were balloon pump use alone (OR = 11.4, p = 0.002), pulmonary vascular resistance > 4 Wood units (OR = 5.7, p = 0.007), pretransplant creatinine > 2.0 mg/dL (OR = 6.9, p = 0.004) and female donor (OR = 8.3, p = 0.002). Recipient age and previous surgery did not affect short‐term survival. Heart transplantation in the current era consistently offers excellent early and 1‐year survival for well‐selected recipients receiving standard donors. Early mortality tends to reflect graft failure while hospital mortality may be more indicative of recipient selection.

While substance use rates among American Indian (AI) adolescents have been compared to those of non-AI youth, statistical tests have not been used to determine whether these rates differ significantly. The literature also has not compared rates within geographic regions. In this research, we used two data sets to address these issues among high school seniors: the Voices of Indian Teens and Monitoring the Future projects. Lifetime substance use among AI youth was significantly higher than it was for non-AI youth for only two substances (marijuana and cocaine); non-AI youth had significantly higher use rates of inhalants and cigarettes. AI youth were significantly higher than non-AI youth for the 30-day use of five of seven substances (marijuana, cocaine, stimulants, alcohol, and barbiturates). However, analysis of the geographic regions revealed different patterns of substance use, with AI youth significantly higher on more lifetime substance use items in one region and non-AI youth significantly higher in another. In addition, AI youth rates were significantly higher on only three of seven substances when region was controlled.

Allograft valves have been used in cardiac valve replacement for over 40 years. Early failures of allograft mitral valve replacement (AMVR) were attributed to inadequate allograft preservation or unsuccessful implantation techniques. Due to an improved understanding of mitral valve function gained from experience in mitral valve reconstruction, improved imaging techniques for preoperative assessment, and improved methods of allograft preservation, there has been a resurgence of interest in AMVR. The use of bioprosthetic valves in children and young adults is characterized by reduced durability and early valve failure. With the use of mechanical valves, there is a significant long-term risk of morbidity and mortality resulting from thrombosis or hemorrhagic complications from anticoagulation. Additionally, anticoagulation is often difficult to manage in children. The advantages of using allograft mitral valves include the avoidance of anticoagulation and the preservation of the subvalvar apparatus and its role in ventricular function. At our institution, successful early results with AMVR have been obtained in eight children and young adults with previous atrioventricular septal defects, previous placement of mitral valve prostheses, rheumatic valvular disease, and bacterial endocarditis. Our early results and those of others are encouraging for the continued use of AMVR in children and young adults. Long-term follow-up will be necessary to assess the durability and function of these allograft mitral valves.

Truncal valve insufficiency is a significant risk factor for post-operative mortality following repair of truncus arteriosus. The surgical management of dysplastic and insufficient truncal valves remains an operative challenge. We report the cases of two infants with type 2 truncus arteriosus and severely dysplastic and insufficient quadricuspid truncal valves. At primary repair, their truncal valves were successfully repaired using pericardial leaflet extensions. This technique may be used in neonates with truncal valve insufficiency as part of the primary repair of truncus arteriosus.