{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:10:49Z","timestamp":1788667849544,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["World J Pediatr Congenit Heart Surg"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A subset of children with congenital heart disease (CHD) travel internationally for definitive cardiac surgery, yet outcome data for selectively referred international patients undergoing complex congenital cardiac procedures remain limited. We describe results for international pediatric cardiac patients operated on within a structured referral model at a US tertiary congenital cardiac center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From September 2020 to July 2025, 1465 patients underwent cardiac surgery at our institution. Sixty-six consecutive international patients underwent 117 procedures, coordinated through Global Services. Demographics, diagnoses, operative variables, and outcomes were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age was 53 months (interquartile range [IQR] 12-140) and weight 15.6\u2005kg (IQR 8.5-39.5); 62% (41\/66) were male. Referring countries were the United Arab Emirates (37\/66, 56%), Kuwait (35%, 23\/66), and Qatar (9%, 6\/66). Prior cardiac surgery occurred in 74% (49\/66), and 58% (38\/66) had \u22652 sternotomies; 25% (17\/66) had single-ventricle physiology. Society of Thoracic Surgeons \u2013 European Association for Cardio-Thoracic Surgery Congenital Heart Surgery category 3 to 5 procedures accounted for 48% (32\/66) of the cases. Median cardiopulmonary bypass time was 174\u2005min (IQR 120-255) and cross-clamp time 83\u2005min (IQR 33-137). There was no hospital mortality. Early reoperation occurred in 7.5% (5\/66) (3% for bleeding). Median intensive care unit and hospital stay were 5 (IQR 3-12) and 11 days (IQR 7-30). Major complications included extracorporeal membrane oxygenation, stroke, and dialysis in 1 patient each (1.5% each) and vocal cord injury in 6\/66 (9%). Over a mean follow up of 312 days, 2 late deaths occurred (6 months and 1 year).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>International patients with CHD can achieve excellent early outcomes despite high complexity when managed at experienced centers with structured referral coordination and multidisciplinary infrastructure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501351261442762","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:04:27Z","timestamp":1788451467000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Congenital Cardiac Surgery Across Continents: Excellent Outcomes With Patients From the Middle East Operated on in the United States"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6293-7897","authenticated-orcid":false,"given":"Muhammed Ikbal","family":"Aydin","sequence":"first","affiliation":[{"name":"Children's National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Cummins","sequence":"additional","affiliation":[{"name":"Children's National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Smith","sequence":"additional","affiliation":[{"name":"Children's National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard R.","family":"Martin","sequence":"additional","affiliation":[{"name":"Children's National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne J.","family":"Franklin","sequence":"additional","affiliation":[{"name":"Children's National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Aljiffry","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1851-7836","authenticated-orcid":false,"given":"Yves","family":"d\u2019Udekem","sequence":"additional","affiliation":[{"name":"Children's National Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(19)30402-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.04.008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2010.02.005"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2009.11.006"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.01.105"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2870"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000691"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.03.062"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2021.04.088"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150135120937230"},{"key":"e_1_3_2_12_2","unstructured":"Understanding country income: World Bank Group income classifications for FY26. World Bank Blogs. Accessed March 12 2026. https:\/\/blogs.worldbank.org\/en\/opendata\/understanding-country-income\u2013world-bank-group-income-classifica"},{"key":"e_1_3_2_13_2","unstructured":"Congenital Heart Surgery Database. | STS public reporting. Accessed December 29 2025. https:\/\/publicreporting.sts.org\/chsd-about."},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2019.00359"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046962"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.18502\/jthc.v19i2.16202"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf317"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.09.075"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1460342"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501351241239316"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501351231204328"}],"container-title":["World Journal for Pediatric and Congenital Heart Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501351261442762","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501351261442762","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501351261442762","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T03:34:39Z","timestamp":1788665679000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501351261442762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":20,"alternative-id":["10.1177\/21501351261442762"],"URL":"https:\/\/doi.org\/10.1177\/21501351261442762","relation":{},"ISSN":["2150-1351","2150-136X"],"issn-type":[{"value":"2150-1351","type":"print"},{"value":"2150-136X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"21501351261442762"}}