The International Society for Heart and Lung Transplantation released 2025 guidelines for the management of heart failure in children, which is an update of the 2014 edition.The new guidelines deeply integrate major advancements in the field of adult heart failure (such as the application of angiotensin receptor-neprilysin inhibitors and sodium-dependent glucose transporters 2 inhibitor) with the uniqueness and complexity of pediatric heart failure.They propose more refined heart failure staging, classification, diagnostic evaluation processes, and treatment strategies while systematically emphasizing, for the first time, the importance of complication management and palliative care.This article aims to provide an in-depth interpretation of the core updates and highlights of 2025 guidelines and offer insights and recommendations for clinical practice, research directions, and the revision of guidelines/consensus in the field of pediatric heart failure in China based on China′s national conditions.

The International Society for Heart and Lung Transplantation released 2025 guidelines for the management of heart failure in children, which is an update of the 2014 edition.The new guidelines deeply integrate major advancements in the field of adult heart failure (such as the application of angiotensin receptor-neprilysin inhibitors and sodium-dependent glucose transporters 2 inhibitor) with the uniqueness and complexity of pediatric heart failure.They propose more refined heart failure staging, classification, diagnostic evaluation processes, and treatment strategies while systematically emphasizing, for the first time, the importance of complication management and palliative care.This article aims to provide an in-depth interpretation of the core updates and highlights of 2025 guidelines and offer insights and recommendations for clinical practice, research directions, and the revision of guidelines/consensus in the field of pediatric heart failure in China based on China′s national conditions.

Objective　To explore the effect of amrinone and aprotinin on whole-body inflammatory response in the patients with prosthetic valve replacement during perioperative period. Methods　24 patients undergoing prosthetic valve replacment were randomized to control group (group A, n=8) , aprotinin group (group B, n=8) and amrinone combined with aprotinin group (group C, n=8). In the aprotinin group, 3×106 of aprotinin was added to the priming solution of the extracorporeal circulation (ECC). In the amrinone combined with aprotinin group 3×106 of aprotinin was added to the priming solution of the ECC and amrinone began with a bolus of 1mg/kg followed by a maintenance infusion of 8μg/(kg*min). The control group received an equivalent prime volume without aprotinin. Venous blood samples were drawn before the operation, at the end of ECC, 1 hour after the end of ECC, and one day after the operation respectively. Enzyme-linked immunosorbent assay techniques were used to measure each of the cytokines. Results　Before ECC, there were no differences of the levels of IL-6 and IL-8 among groups (P>0.05). After ECC, the levels of IL-6 and IL-8 increased significantly in all groups (P<0.05). The levels on day one after the operation were still higher than those before the operation in all groups (except the level of IL-8 in group C), but no statistical significance was observed. (P>0.05). At 1 hour after the end of ECC, the level of IL-6 in group B was lower than that in group A, and the level of IL-6 in group C was lower than that in group B, but there was no statistically significant difference (P>0.05）；At the end of ECC, the level of IL-8 in group B was lower than that in group A and the level of IL-8 in group C was lower than that in group B, but no significant difference was noted (P>0.05). It was also observed that the level of IL-8 was lower in group C than group A or B at 1 hour after the end of ECC. Conclusion　Although amrinone and aprotinin have antiinflammatory activity, but pump prime only aprotinin or aprotinin combined with amrinone may fail in preventing proinflammatory cytokine release (IL-6, IL-8) completely in patients with prosthetic valve replacement during ECC perioperative period.