Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

A variety of cell types respond to electrical stimuli, accordingly many conducting polymers (CPs) have been used as tissue engineering (TE) scaffolds, one such CP is polypyrrole (PPy). PPy is a well studied biomaterial with potential TE applications due to its electrical conductivity and many other beneficial properties. Combining its characteristics with an elastomeric material, such as polyurethane (PU), may yield a hybrid scaffold with electrical activity and significant mechanical resilience. Pyrrole was in situ polymerized within a PU emulsion mixture in weight ratios of 1:100, 1:20, 1:10 and 1:5, respectively. Morphology, electrical conductivity, mechanical properties and cytocompatibility with C2C12 myoblast cells were characterized. The polymerization resulted in a composite with a principle base of PU interspersed with an electrically percolating network of PPy nanoparticles. As the mass ratio of PPy to PU increased so did electrical conductivity of the composites. In addition, as the mass ratio of PPy to PU increased, stiffness of the composite increased while maximum elongation length decreased. Ultimate tensile strength was reduced by approximately 47% across all samples with the addition of PPy to the PU base. Cytocompatibility assay data indicated no significant cytotoxic effect from the composites. Static cellular seeding of C2C12 cells and subsequent differentiation showed myotube formation on the composite materials.

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Background: Data are lacking regarding the insurance status of adults with congenital heart disease (ACHD). We investigated whether the Affordable Care Act (ACA) impacted insurance status among hospitalized ACHD, identified associated sociodemographic factors, and compared coverage to adults with other chronic childhood conditions. Methods: Serial cross-sectional analysis of National Inpatient Sample hospitalizations from 2007 to 2016 was performed for patients 18-64 years old. ACHD were identified using ICD-9/10-CM codes and compared to patients with sickle cell disease (SCD), cystic fibrosis (CF), and the general population. Age was dichotomized as 18-25 years (transition aged) or 26-64 years. Groups were compared by era (pre-ACA [January 2007-June 2010]; early-ACA [July 2010-December 2013], which eliminated pre-existing condition exclusions; and full-ACA [January 2014-December 2016]) using interrupted time series and multivariable Poisson regression analyses.Results: Overall, uninsured hospitalizations decreased from pre-ACA (12.0%) to full-ACA (8.5%). After full ACA implementation, ACHD had lower uninsured rates than the general hospitalized population (6.0 vs. 8.6%, p < .01), but higher rates than those with other chronic childhood diseases (SCD [4.5%]; CF [1.6%]). Across ACA eras, transition aged ACHD had higher uninsured rates than older patients (8.9 vs. 7.6%, p < .01), and Hispanic patients remained less insured than other groups.Conclusions: Hospitalized ACHD were better insured than the general population but less insured than those with SCD or CF. Full ACA implementation was associated with improved insurance coverage for all groups, but disparities persisted for transition aged and Hispanic patients. Ongoing evaluation of the effects of insurance and health policy on ACHD remains critical to diminish health disparities.

Experimental subpulmonary assist device for Fontan circulation: von Karman impeller pump. Central Message Patients with Fontan circulation experience sequelae related to chronic attrition from altered hemodynamics; a subpulmonary assist device may improve cardiovascular status and alleviate symptoms. Perspective Investigators have formulated creative solutions to address the unmet need for subpulmonary Fontan circulation assistance, but substantial clinical translation has not been realized. In this article, we review experimental and clinical attempts for cavopulmonary assistance in patients with single ventricles and highlight promising strategies to create a subpulmonary assist device for the Fontan circulation.

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In this study population, renal dysfunction in patients with Fontan circulation is associated with increased CVP and factors that affect CVP. African Americans with Fontan circulation may be at particular risk for renal dysfunction. Continued investigation of the effects of venous congestion on kidneys and other factors associated with renal dysfunction in patients with Fontan circulation is warranted.

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