Long-Term Risk of Heart Failure-Related Death and Heart Transplant After Congenital Heart Surgery in Childhood (from the Pediatric Cardiac Care Consortium)

The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) is the largest professional organization in the world dedicated to pediatric and congenital heart surgery. The purpose of this article is to document the first decade of the history of WSPCHS from its formation in 2006, to summarize the current status of WSPCHS, and to consider the future of WSPCHS. The WSPCHS was incorporated in Canada on April 7, 2011, with a head office in Montreal, Canada. The vision of the WSPCHS is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The mission of the WSPCHS is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research, and community service.

Download Full-text

Prescription medication use after congenital heart surgery

Cardiology in the Young ◽

10.1017/s1047951121005060 ◽

2022 ◽

pp. 1-8

Author(s):

Alireza Raissadati ◽

Jari Haukka ◽

Tommi Pätilä ◽

Heta Nieminen ◽

Eero Jokinen

Keyword(s):

General Population ◽

Congenital Heart ◽

Heart Surgery ◽

Medication Use ◽

Prescription Medication ◽

Congenital Heart Surgery ◽

Hazard Ratio ◽

Prescription Medications

Abstract Background: Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. Methods: Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. Results: Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7–2.1; severe hazard ratio 6.5, 95% confidence interval 5.3–8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8–3.7; severe hazard ratio 38.8, 95% CI 27.5–54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. Conclusions: The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.

Download Full-text

Abstract P180: Hospital Readmission After Pediatric Congenital Heart Surgery: A Systematic Review And Meta-analysis Of Potential Risk Factors

Circulation ◽

10.1161/circ.143.suppl_1.p180 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Meagan E Stabler ◽

Devin M Parker ◽

Sarina Kothari ◽

Mahalia Dalmage ◽

Heather Johnson ◽

...

Keyword(s):

Hospital Readmission ◽

Congenital Heart ◽

Heart Surgery ◽

Meta Analysis ◽

Hospital Readmissions ◽

Congenital Heart Surgery ◽

Risk Of Bias ◽

Factors Associated ◽

Short And Long Term

Objective: Over 40,000 infants are born annually with a heart defect; 25% require surgery and of those 20% result in hospital readmissions. We sought to identify risk factors for short- and long-term readmission following pediatric congenital heart surgery (CHS) to reduce avoidable future admissions. Methods: A systematic approach was used to search four electronic databases and retrieve articles published through 05/2020. We included observational and experimental studies that observed factors associated with 30-day or 1-year readmission after CHS. Studies with a composite outcome of readmission and death were excluded. For each independent risk factor, we assessed the pooled effect size and heterogeneity using a random-effects model. Risk of bias was assessed via the Newcastle-Ottawa scale. Results: After removing 970 duplicates, we screened 5,084 studies; 17 were included in the systematic review and 15 (N= 82,794; 9,856 readmitted) in the meta-analysis. Hospital readmission was significantly and positively associated with gestational age, non-white race, Hispanic ethnicity, government insurance, genetic abnormality, renal dysfunction, failure to thrive, mechanical ventilation, intraoperative ventricular dysfunction, RACHS score, STAT mortality score, cross clamp time, gastroesophageal reflux disease, postoperative arrhythmia, valve regurgitation, feeding difficulties, and ICU and hospital length of stay (LOS). Readmission definition (i.e., 1-yr vs 30-day) and LOS dichotomization (i.e., ≥ 10 or ≥ 14) resulted in significant subgroup differences for age at surgery and LOS. Five studies had higher potential for risk of bias. Conclusions: This is the first meta-analysis to identify patient and clinical factors associated with short and long-term readmission after pediatric CHS. Findings may support clinical decisions before undergoing surgery and identify patients that may benefit from receiving more aggressive care transitions prior to discharge to reduce avoidable hospital readmissions.

Download Full-text

Trends in Long-Term Mortality After Congenital Heart Surgery

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.03.491 ◽

2018 ◽

Vol 71 (21) ◽

pp. 2434-2446 ◽

Cited By ~ 43

Author(s):

Logan G. Spector ◽

Jeremiah S. Menk ◽

Jessica H. Knight ◽

Courtney McCracken ◽

Amanda S. Thomas ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Long Term Mortality

Download Full-text

Outcomes of home mechanical ventilation with tracheostomy after congenital heart surgery

Cardiology in the Young ◽

10.1017/s1047951121001657 ◽

2021 ◽

pp. 1-5

Author(s):

Bahar Temur ◽

İsmet E Emre ◽

Selim Aydın ◽

Mehmet A Önalan ◽

Serdar Başgöze ◽

...

Keyword(s):

Mechanical Ventilation ◽

Median Duration ◽

Congenital Heart ◽

Heart Surgery ◽

Total Mortality ◽

Congenital Heart Surgery ◽

Home Mechanical Ventilation ◽

Significant Difference

Abstract Objective: After congenital heart surgery, some patients may need long-term mechanical ventilation because of chronic respiratory failure. In this study, we analysed outcomes of the patients who need tracheostomy and home mechanical ventilation. Methods: Amongst 1343 patients who underwent congenital heart surgery between January, 2014 and June, 2018, 45 needed tracheostomy and HMV. The median age of these patients was 6.4 months (12 days–6.5 years). Nineteen patients underwent palliation while 26 patients underwent total repair. Post-operative diaphragm plication was performed in five patients (11%). Median duration of mechanical ventilation before tracheostomy was 32 days (8–154 days). The patients were followed up with their home ventilators in ward and at home. Mean follow-up time was 36.24 ± 11.61 months. Results: The median duration of ICU stay after tracheostomy was 27 days (range 2–93 days). Follow-up time in ward was median 30 days (2–156 days). A total of 12 patients (26.6%) were separated from the ventilator and underwent decannulation during hospital stay. Thirty-two patients (71.1%) were discharged home with home ventilator support. Of them, 15 patients (46.9%) were separated from the respiratory support in median of 6 weeks (1 week–11 months) and decannulations were performed. Total mortality was 31.1%. in which four patients are still HMV dependent. There was no significant difference for decannulation between total repair and palliation patients. Conclusion: HMV via tracheostomy is a useful option for the treatment of children who are dependent on long-term ventilation after congenital heart surgery although there are potential risks.

Download Full-text