Patients on extracorporeal membrane oxygenation (ECMO) who suffer vascular complications frequently accrue additional procedures and costs. We sought to evaluate the effect of ECMO-related vascular complications on hospital charges and in-hospital mortality. Adult discharges involving ECMO from 2004 to 2013 in the National Inpatient Sample were examined. There were 12,636 patients in the cohort. Vascular complications, focusing on arterial complications were identified using ICD-9-CM diagnosis and procedure codes. A multivariable survey linear regression model using median hospital charges was used to model the effect of vascular complications on charges. We used multivariable survey logistic regression to evaluate the effect of vascular complications on in-hospital mortality. Of the 12,636 patients examined, 6467 (51.2%) had ECMO-related vascular complications. Median charges in patients with vascular complications were $ 477,363 (interquartile range 258,660-875,823) and were $ 282,298 (interquartile range 130,030-578,027) without vascular complications. On multivariable analysis, patients with vascular complications had 24% higher median charges than patients without vascular complications (Ratio 1.24; 95% confidence interval [CI] 1.16-1.33; P less then 0.0001) and 34% higher odds of experiencing in-hospital mortality than patients without vascular complications (adjusted odds ratio 1.34; 95% CI1.08-1.66; P = 0.009). Vascular complications occur in over half of ECMO patients and are associated with an increased risk of high hospital charges and in-hospital mortality. These findings support the need for identification and modification of risk factors for ECMO-related vascular complications. Furthermore, the standardization of protocols using evidence-based measures to mitigate vascular complications may improve overall ECMO outcomes.The Fontan is the final common pathway for most single ventricle lesions. It is not a durable circulation and many Fontan patients eventually present for advanced heart failure therapies including mechanical circulatory support. While there have been advancements in available durable devices, many pediatric patients have size, anatomical, and physiologic constraints that make placement of adult ventricular assist devices challenging. And, Fontan failure comes in different varieties, including failure with preserved systolic function. This subset of patients requires either a subpulmonary assist device or a total artificial heart. Unique operative maneuvers, including atrial cannulation and atrioventricular valve manipulation have allowed many failing Fontan patients to be bridged to transplant after recovery of end-organ dysfunction and improved nutrition. The Advanced Cardiac Therapies Improving Outcomes Network is a multicenter learning network of pediatric hospitals implanting, managing, and studying ventricular assist devices in children and adults with congenital heart disease. This network is advancing the knowledge of outcomes and approaches to mechanical circulatory support in those with congenital heart disease, including Fontans. The congenital heart disease community continues to work toward and hope for a smaller durable device that will help this complex cohort of patients.Functional tricuspid regurgitation (FTR) is thought to arise due to annular dilation and alteration of right ventricular (RV) geometry in the presence of normal leaflets, yet mitral leaflets have been shown to remodel significantly in functional mitral regurgitation. We set out to evaluate tricuspid valve anterior leaflet deformations in ovine FTR. Eleven animals (FTR group) underwent implantation of a pacemaker with high rate pacing to induce biventricular dysfunction and at least moderate TR. Subsequently, both FTR (n = 11) and Control (n = 12) animals underwent implantation of 6 sonomicrometry crystals around the tricuspid annulus, 4 on the anterior leaflet, and 14 on RV epicardium. Tricuspid valve geometry and anterior leaflet strains were calculated from crystal coordinates. Left ventricular ejection fraction and RV fractional area change were significantly lower in FTR animals versus Control. Tricuspid annular area, septo-lateral diameter, RV pressures were all significantly greater in the FTR group. CX-4945 concentration Mean TR grade (+0-3) was 0.7 ± 0.5 in Control and 2.4 ± 0.5 in FTR (P =  less then 0.001). The anterior leaflet area and length increased significantly. Global radial leaflet strain was significantly lower in FTR mostly driven by decreased free edge leaflet strain. Global circumferential anterior leaflet strain was also significantly lower in FTR with more remarkable reduction in the belly region. Rapid ventricular pacing in sheep resulted in a clinically pertinent model of RV and annular dilation with FTR and leaflet enlargement. Both circumferential and radial anterior leaflet strains were significantly reduced with FTR. Functional TR may be associated with alteration of leaflet mechanical properties.The present study aimed to assess the impact of retrograde autologous priming (RAP) on hemodynamics and pulmonary mechanics in children subjected to cardiothoracic surgery. This prospective randomized study analyzed the clinical records of 124 children with risk adjustment in congenital heart surgery-1 left to right lesions subjected to cardiac surgery. They comprised 64 patients in RAP group and 60 patients in the conventional priming group. The preoperative, intraoperative and postoperative data of the studied patients were reported. The outcome measures included hematocrit (Hct) value, blood gases, lung mechanics parameters, transfusion needs, ICU stay, postoperative complications and mortality. Preoperatively, there were no significant differences between the studied groups regarding the demographic data, underlying lesions, laboratory data, blood gases and pulmonary mechanics parameters. Intraoperatively, RAP group patients had significantly lower amount of blood loss, less frequent need to packed red blood cells (RBC)s transfusion and better Hct values when compared with the control group. Postoperatively, RAP group patients had significantly higher Hct% at ICU arrival, significantly better pulmonary mechanics parameters and significantly shorter duration on mechanical ventilation. RAP in children older than 12 months subjected to cardiac surgery for risk adjustment in congenital heart surgery-1 left to right lesions is associated with less transfusion needs and better pulmonary mechanics.