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Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy

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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Pediatric Cardiology and Congenital Heart Disease".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 14086

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Special Issue Editor

Prof. Dr. Martin Schweiger

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Guest Editor

1. Pediatric Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
2. Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
Interests: congenital cardiac surgery; heart transplantation; tissue engineering; assist devices; congenital pediatric heart surgery

Special Issue Information

Dear Colleagues,

By investing in technological innovations in cardiac surgery and intervntional therapy we can improve the quality of life for patient suffering from CHD. The objectives of this Special Issue are to review the current landscape of technological innovations in cardiac surgery and cardiac interventions in pediatric and adult CHD patients. By analyzing the current state we will identify gaps and areas where further innovation is needed. This will help us to focus on developing solutions that adress the unmet needs of patients with CHD.

We aim to drive forward these innovations and contribute to a better outcome for individuals living with CHD.

Prof. Dr. Martin Schweiger
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

minimal invasive procedures in pediatric cardiac surgery
3D printing
advanced imaging modalities
bioresorbable devices
artificial intelligence
tissue engineering
growth

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Published Papers (7 papers)

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Research

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17 pages, 5699 KB

Open AccessArticle

Establishment of an MR-Conditional Porcine Model for Real-Time Assessment of Cerebral Blood Flow During Extracorporeal Circulation

by Michael Hofmann, Martin O. Schmiady, Dominik T. Schulte, Tobias Aigner, Rima Bektas, Manuela Wieser, Martina Lentini, Francesca Del Chicca, Christoph Loeschmann, Michael Hübler, Ruth O’Gorman Tuura, Marianne Schmid Daners and Henning Richter

J. Cardiovasc. Dev. Dis. 2026, 13(5), 182; https://doi.org/10.3390/jcdd13050182 - 27 Apr 2026

Viewed by 164

Abstract

Background and Purpose: Neurological injury remains a major complication of pediatric cardiac surgery and is closely related to alterations in cerebral blood flow during extracorporeal circulation (ECC). However, the real-time assessment of cerebral perfusion under these conditions has been limited by the lack of magnetic resonance (MR)-compatible perfusion systems. The aim of this pilot feasibility study was to establish a porcine model enabling simultaneous cardiopulmonary bypass (CPB) and real-time MR-based assessment of cerebral blood flow during simulated pediatric cardiac surgery. Methods: We conducted a pilot study on 11 Duroc pigs (14.6 ± 1.4 kg BW), designed in iterative cycles. The experimental setup included an MR-conditional heart-lung machine and a surgical protocol closely mimicking pediatric cardiac surgery. After the initiation of CPB and hemodynamic stabilization, animals were cooled to target temperatures (20 °C or 28 °C) depending on the perfusion strategy. Structural and functional MRI, including phase-contrast imaging, arterial spin labeling, diffusion-weighted imaging, and MR spectroscopy, were performed during cooling and rewarming. Procedural feasibility, technical challenges, and optimization strategies were systematically documented. Results: The study successfully established a reproducible porcine model enabling MR imaging during extracorporeal circulation. Key technical challenges, including vascular access, cannulation of the ascending aorta, and blood volume management, were identified and addressed through the iterative refinement of the surgical and perfusion protocols. The use of the Seldinger technique significantly improved cannulation safety and reduced blood loss. Stable CPB conditions and target hypothermic temperatures were achieved in successfully cannulated animals. MRI acquisition during CPB was feasible, providing simultaneous structural and functional assessment of cerebral perfusion. Representative imaging data demonstrate the capability of the model to capture cerebral hemodynamics in real time. Conclusions: This pilot study establishes a novel MR-compatible porcine model for the real-time assessment of cerebral blood flow during extracorporeal circulation. The platform provides a robust foundation for future quantitative investigations of cerebral perfusion, mechanisms of brain injury, and neuroprotective strategies in pediatric cardiac surgery. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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14 pages, 1616 KB

Open AccessArticle

Echocardiographic Features and Clinical Outcomes of Functional vs. Anatomical Pulmonary Atresia with Intact Ventricular Septum in Neonates

by Yalun Qu, Shuang Yang, Yuefeng Cao, Jiachen Li, Zhongyi Han, Dong Wang, Yao Yang, Yongtao Wu and Qiang Wang

J. Cardiovasc. Dev. Dis. 2026, 13(2), 95; https://doi.org/10.3390/jcdd13020095 - 15 Feb 2026

Viewed by 537

Abstract

(1) Background: Functional pulmonary atresia (FPA) and pulmonary atresia with intact ventricular septum (PA/IVS) are rare neonatal congenital heart diseases with similar early clinical manifestations but distinct pathophysiology and treatment strategies, making early and accurate differentiation clinically important. (2) Methods: This single-center retrospective study included 43 neonates diagnosed with FPA (n = 12) or PA/IVS (n = 31) between December 2016 and March 2025. Echocardiographic parameters and clinical data were compared between groups, and receiver operating characteristic curve analysis was performed to evaluate the usefulness of selected echocardiographic indices for differentiation in clinical practice. (3) Results: Compared with PA/IVS, neonates with FPA exhibited significantly larger right atrial area, relatively better preserved right ventricular development, larger patent ductus arteriosus diameter, and lower peak tricuspid regurgitation velocity. Several parameters, including right atrial area and the right-to-left ventricular ratio, demonstrated strong between-group discrimination in this cohort. Clinically, most FPA neonates were managed conservatively with favorable outcomes, whereas PA/IVS neonates required surgical intervention and experienced higher perioperative mortality. (4) Conclusions: FPA and PA/IVS differ significantly in right heart morphology, hemodynamic characteristics, and management strategies. A comprehensive multi-parameter echocardiographic evaluation demonstrated discriminatory ability in this cohort, facilitating appropriate treatment decisions and potentially helping to avoid unnecessary high-risk surgical interventions. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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19 pages, 667 KB

Open AccessArticle

Comparison of Clinical Features and Hemodynamics of Single Ventricle Patients With and Without Interventional Closure of Veno-Venous or Aortopulmonary Collaterals

by Helena Link, Alessia Callegari, Walter Knirsch, Oliver Kretschmar and Daniel Quandt

J. Cardiovasc. Dev. Dis. 2025, 12(11), 444; https://doi.org/10.3390/jcdd12110444 - 13 Nov 2025

Viewed by 833

Abstract

In single ventricle (SV) patients, veno-venous (VVCs) and major aortopulmonary collaterals (APCs) are common. We aim to determine the differences between patients with and without interventional closure of VVCs or APCs in this single-center, retrospective analysis of 135 SV patients (2006–2021). Anatomical, surgical and clinical features, hemodynamics and PA dimensions were compared. VVC closure was performed in 34 (25%) patients. VVC closure was associated with comprehensive stage I + II (p = 0.05), left PA patch procedure (p = 0.04), Fontan fenestration (p < 0.001), PA pressure >/= 16 mmHg pre-BCPC (p = 0.04) and >/= 15 mmHg pre-TCPC (p = 0.021), lower saturation pre-TCPC (p = 0.04) and smaller PAs (Nakata p = 0.03, total lower lobe index p = 0.001). Patients with VVC closure had a longer hospitalization post-BCPC (p = 0.008) and post-TCPC (p = 0.04) and longer ICU time post-BCPC (p = 0.04). APC closure was performed in 53 (39%) patients. Male sex (p = 0.001), Norwood I procedure (p = 0.04), younger age at BCPC (p = 0.02), higher end-diastolic pressure pre-TCPC (p = 0.04), lower oxygen levels pre-BCPC (p < 0.001) and smaller PAs (Nakata p = 0.08; McGoon p < 0.001) were related to APC closure. Patients with APC closure had a longer hospital (p < 0.001) and ICU (p = 0.005) stay post-TCPC. Significant VVC and APCs are linked to poorer PA growth, worse hemodynamics, lower sats and prolonged hospital/ICU stays, highlighting the need for targeted attention. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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12 pages, 1522 KB

Open AccessEditor’s ChoiceArticle

Unifocalization of Major Aortopulmonary Collateral Arteries (MAPCAs) and Native Pulmonary Arteries in Infancy—Application of 3D Printing and Virtual Reality

by Jacek Kolcz, Anna Rudek-Budzynska and Krzysztof Grandys

J. Cardiovasc. Dev. Dis. 2024, 11(12), 403; https://doi.org/10.3390/jcdd11120403 - 13 Dec 2024

Cited by 3 | Viewed by 3478

Abstract

Background. Major aortopulmonary collateral arteries (MAPCAs) are rare remnants of pulmonary circulation embryological development usually associated with complex congenital anomalies of the right ventricular outflow tract and pulmonary arteries. Effective management requires surgical unifocalization of MAPCAs and native pulmonary arteries (NPAs). Traditional imaging may lack the spatial clarity needed for precise surgical planning. Aim. This study evaluated the feasibility of integrating three-dimensional (3D) printing and virtual reality (VR) into preoperative planning to improve surgical precision, team communication, and parental understanding. In a prospective cohort study, nine infants undergoing MAPCA unifocalization were included. Four patients underwent conventional imaging-based planning (control), while five were additionally assessed using VR and 3D-printed models (intervention). The outcomes measured included operative times, team confidence, collaboration, and parental satisfaction. Statistical analysis was performed using standard tests. Results. The intervention group had shorter operative and cardiopulmonary bypass times compared to the control group. Intraoperative complications were absent in the VR/3D group but occurred in the control group. Medical staff in the VR/3D group reported significantly improved understanding of anatomy, surgical preparedness, and team collaboration (p < 0.05). Parents also expressed higher satisfaction, with better comprehension of their child’s anatomy and surgical plan. Conclusions. VR and 3D printing enhanced preoperative planning, surgical precision, and communication, proving valuable for complex congenital heart surgery. These technologies offer promising potential to improve clinical outcomes and patient–family experiences, meriting further investigation in larger studies. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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11 pages, 1297 KB

Open AccessArticle

BeGraft Aortic Stents: A European Multi-Centre Experience Reporting Acute Safety and Efficacy Outcomes for the Treatment of Vessel Stenosis in Congenital Heart Diseases

by Micol Rebonato, Mara Pilati, Sophie Malekzadeh Milani, Damien Bonnet, Emma Pascall, Matthew Jones, Pedro Betrian, Lisa Bianco, Hugues Lucron, Sebastien Hascoet, Alban-Elouen Baruteau, Luca Giugno and Gianfranco Butera

J. Cardiovasc. Dev. Dis. 2024, 11(7), 192; https://doi.org/10.3390/jcdd11070192 - 25 Jun 2024

Cited by 3 | Viewed by 4188

Abstract

Background: Stent implantation has become the preferred method of treatment for treating vessel stenosis in congenital heart diseases. The availability of covered stents may decrease complications and have an important role in the management of patients with complex anatomy. Aim: This study aims to evaluate the feasibility and safety of the pre-mounted cobalt–chromium stent-graft-covered ePTFE Aortic BeGraft in a broad spectrum of vascular lesions. Methods: This is a multicenter retrospective results analysis of 107 implanted BeGraft stents between 2016 and 2022 in six different European centers. Results: One hundred and four patients with a mean age of thirteen years (range 1–70 years) and with the body weight of 56.5 kg (range 11–115 kg) underwent the BeGraft stent implantation. Stents were implanted in the following conditions: aortic coarctation (74 patients), RVOT dysfunction (12 patients), Fontan circulation (7 patients), and miscellaneous (11 subjects with complex CHD). All the stents were implanted successfully. The median stent diameter was 16 mm (range 7–24 mm), and the median length was 39 mm (range 19–49 mm). Major complications occurred in five subjects (4.7%). During a median follow-up of fourteen (1–70) months, stents’ re-dilatation was performed in five patients. Conclusions: The BeGraft stent can be used safely and effectively in a wide spectrum of congenital heart diseases. Whether these good results will be stable in the longer term still needs to be investigated in a follow-up given its recent introduction into clinical practice, in particular regarding stent fracture or neointimal proliferation. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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Review

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13 pages, 1861 KB

Open AccessReview

Late Complications After Aortic Coarctation Repair

by Annarita Santoro, Fiorenza De Lisio, Alexandra Fedorovna Bezborodova, Roberto Chiesa and Germano Melissano

J. Cardiovasc. Dev. Dis. 2025, 12(11), 450; https://doi.org/10.3390/jcdd12110450 - 19 Nov 2025

Viewed by 2072

Abstract

Aortic coarctation (CoA) is a congenital vascular anomaly characterized by luminal narrowing of the aorta, representing approximately 5–8% of all congenital heart defects, and is frequently associated with a bicuspid aortic valve and additional vascular malformations. The clinical spectrum is broad, ranging from severe neonatal heart failure to asymptomatic systemic hypertension in adulthood, with the severity of presentation directly influencing the timing of diagnosis and therapeutic intervention. Over recent decades, management strategies have transitioned from conventional surgical techniques—such as end-to-end anastomosis, subclavian flap aortoplasty, and patch augmentation—to endovascular modalities including balloon angioplasty and stent implantation, with covered stents now constituting the preferred approach in most cases. Nonetheless, late complications remain clinically significant. Post-coarctation aneurysms (pCoAA), particularly following patch aortoplasty, have been reported in up to 50% of patients and necessitate lifelong imaging surveillance. Re-coarctation persists as a therapeutic challenge, especially in neonates, with recurrence risk influenced by anatomical factors and the initial repair method. Optimal outcomes require an individualized, anatomy-tailored approach that judiciously integrates surgical, endovascular, and hybrid techniques. Lifelong surveillance remains essential to mitigate long-term risks, including systemic hypertension, aneurysm formation, and the need for re-intervention. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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Other

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6 pages, 755 KB

Open AccessCase Report

Paediatric HeartMate 3™, the Uneventful 22-Month Journey to Transplantation of a 14-Year-Old-Patient—Time for Prolonged LVAD Support in Children?

by Clemens Haselmann, Sonja Budäus, Michael Zellner, Robert Cesnjevar and Martin Schweiger

J. Cardiovasc. Dev. Dis. 2024, 11(9), 288; https://doi.org/10.3390/jcdd11090288 - 18 Sep 2024

Cited by 1 | Viewed by 1602

Abstract

We report on a 14-year-old patient who was supported for nearly two years with an ic-LVAD and managed to complete his journey to transplantation without a single complication. Although mechanical assist device support is available for children up to 20 kg in body weight, availability is limited to paracorporeal devices. Intracorporal (ic) left ventricular assist devices (LVADs) for infants in the suitable weight class are a viable option as a bridge-to-transplant, where they make up more than 50% of transplant candidates in their category. A teenager with 59 kg body weight was newly diagnosed with DCM and listed for heart transplantation. After initially being on VA-ECMO, an Abbott HeartMate 3 LVAD with postoperative temporary RVAD support was initialised. RV-support was maintained for 10 days. The further postoperative course was uneventful, and he was discharged on day 98. He was seen regularly in the outpatient department and integrated into school routine again, following the extensive training of his classmates and the responsible school staff. After a total of 672 days on support, he was successfully transplanted. There were no unplanned admissions, thrombotic nor bleeding events, as well as no driveline infection, even though the patient participated in sport classes at school. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Technological Innovations in Cardiac Surgery and Interventional Therapy)

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