Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

Abstract Background Patients with congenital heart disease require surgery to correct the cardiac defect they had in order to prevent heart failure. Unfortunately, data regarding outcome of adult CHD in Indonesia is still limited. In contrast with developed countries, many congenital heart surgery patients in developing countries are adults. The purpose of this study was to investigate the outcomes of cardiac surgery procedures among adult congenital heart disease patients, and what factors that might influence the outcome of surgery. Methods A retrospective study was performed on adult congenital heart disease patients undergoing cardiac surgery at Dr. Sardjito Hospital between April 2018 and March 2019. Variables included in the study were demographic characteristics, laboratory test results, comorbidities, premedication, Cardiopulmonary Bypass (CPB) and ischemia duration were included in the analysis. Outcomes were in-hospital mortality, hospital length of stay, and ICU length of stay. Results A total of 25 congenital heart disease patients [19 Atrial Septeal Defect (ASD) patients, and 6 Ventricular Septal Defect (VSD) patients] underwent a cardiac surgery procedure at Dr. Sardjito Hospital during the study period. Mean age was 31 ± 14.92 years. The majority of patients had pulmonary hypertension. During the study period, none of the patients died during postoperative care in the hospital, mean hospital length of stay (LOS) was 8.35 ± 3.39 days and ICU LOS was 26.53 ± 11.33 h. Conclusion Surgery in adult patients with congenital heart disease may be successfully performed with low morbidity and mortality.

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Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Cardiology in the Young ◽

10.1017/s1047951119002671 ◽

2019 ◽

Vol 30 (1) ◽

pp. 62-65 ◽

Cited By ~ 3

Author(s):

Cortney B. Foster ◽

Antonio G. Cabrera ◽

Dayanand Bagdure ◽

William Blackwelder ◽

Brady S Moffett ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Hospital Length Of Stay ◽

P Value ◽

Diaphragm Dysfunction

AbstractBackground:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

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The impact of medical interventions on admission characteristics in children with congenital heart disease and cardiomyopathy

Cardiology in the Young ◽

10.1017/s1047951120004175 ◽

2020 ◽

pp. 1-8

Author(s):

Rohit S. Loomba ◽

Jacqueline Rausa ◽

Vincent Dorsey ◽

Ronald A. Bronicki ◽

Enrique G. Villarreal ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Unit Length ◽

Channel Blockers ◽

Regression Analyses ◽

Converting Enzyme Inhibitors ◽

Medical Interventions ◽

The Impact

Abstract Introduction: Children with congenital heart disease and cardiomyopathy are a unique patient population. Different therapies continue to be introduced with large practice variability and questionable outcomes. The purpose of this study is to determine the impact of various medications on intensive care unit length of stay, total length of stay, billed charges, and mortality for admissions with congenital heart disease and cardiomyopathy. Materials and methods: We identified admissions of paediatric patients with cardiomyopathy using the Pediatric Health Information System database. The admissions were then separated into two groups: those with and without inpatient mortality. Univariate analyses were conducted between the groups and the significant variables were entered as independent variables into the regression analyses. Results: A total of 10,376 admissions were included these analyses. Of these, 904 (8.7%) experienced mortality. Comparing patients who experienced mortality with those who did not, there was increased rate of acute kidney injury with an odds ratio (OR) of 5.0 [95% confidence interval (CI) 4.3 to 5.8, p < 0.01], cardiac arrest with an OR 7.5 (95% CI 6.3 to 9.0, p < 0.01), and heart transplant with an OR 0.3 (95% CI 0.2 to 0.4, p < 0.01). The medical interventions with benefit for all endpoints after multivariate regression analyses in this cohort are methylprednisolone, captopril, enalapril, furosemide, and amlodipine. Conclusions: Diuretics, steroids, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta blockers all appear to offer beneficial effects in paediatric cardiomyopathy admission outcomes. Specific agents within each group have varying effects.

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Risk Factors for Seizures and Epilepsy in Children With Congenital Heart Disease

Journal of Child Neurology ◽

10.1177/0883073820904912 ◽

2020 ◽

Vol 35 (7) ◽

pp. 442-447 ◽

Cited By ~ 1

Author(s):

Suman Ghosh ◽

Joseph Philip ◽

Nikita Patel ◽

Jennifer Munoz-Pareja ◽

Dalia Lopez-Colon ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Birth Weight ◽

Brain Injury ◽

High Risk ◽

Length Of Stay ◽

Potential Risk ◽

Congenital Heart ◽

Potential Risk Factors

Objectives: To identify potential risk factors for pre- and postoperative seizures and epilepsy in children with congenital heart disease. Methods: Retrospective cohort study of neonates and infants <3 months of age with congenital heart disease who underwent cardiopulmonary bypass from November 24, 2006, until June 1, 2015. Children with seizures were classified based on time of occurrence into early preoperative, early postoperative, and late postoperative. Children with recurring seizures 30 days after cardiac surgery met criteria for epilepsy. Results: 247 patients completed follow-up; 2.4% had seizures early preoperation and 1.6% early postoperation. Late postoperative epilepsy occurred in 5.3% of the cohort. The majority of seizures in the late postoperative epilepsy group started after 1 year of age (mean 1.53 years, range = 0.18-4.7 years). One of the 13 patients with epilepsy had a seizure during their intensive care unit hospitalization. Potential risk factors for seizures included brain injury ( P < .001), high-risk surgery (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score ≥3, P = .024), and low birth weight ( P < .04). Infants with stroke were more likely to develop epilepsy ( P = .04). Presence of seizures was associated with increased length of stay ( P < .001). Conclusions: Our study suggests an association between children with congenital heart disease diagnosed with stroke in the neonatal/infancy period and the development of epilepsy. These children may not have prior early pre- and postoperative seizures. Risk factors for seizures include brain injury, high-risk surgery, and lower birth weight. Seizures were associated with an increased length of stay but did not necessarily lead to subsequent epilepsy.

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Abstract 19082: Cardiac Events and Mortality During Admissions for Delivery in Women with Congenital Heart Disease

Circulation ◽

10.1161/circ.130.suppl_2.19082 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Robert M Hayward ◽

Elyse Foster ◽

Zian H Tseng

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Cardiac Arrest ◽

Heart Disease ◽

Length Of Stay ◽

Hospital Mortality ◽

Congenital Heart ◽

Cardiac Events ◽

Live Births ◽

History Of

Background: Labor, delivery, and the postpartum period are a time of increased arrhythmia and congestive heart failure (CHF) incidence. With improvements in the treatment of congenital heart disease (CHD), more women are reaching childbearing age and may be at increased risk for cardiac events and mortality during pregnancy and delivery. Methods: The Healthcare Cost and Utilization Project was used to identify admissions for vaginal and cesarean delivery in California hospitals between 1/1/2005 and 12/31/2011. We compared length of stay, in-hospital mortality, incident CHF, cardiac arrest, and incident arrhythmias for women without CHD to women with non-complex CHD (NC-CHD) and complex CHD (C-CHD). Results: We identified 2,720,980 deliveries resulting in 2,770,382 live births (74% of live births in the state over this period), which included 3,218 women with NC-CHD and 248 women with C-CHD. History of CHF was more common in women with CHD (8.1% for C-CHD, 2.6% for NC-CHD, and 0.08% for women without CHD, p<0.00005 for NC-CHD compared to no CHD and for C-CHD compared to no CHD). Those with CHD were more likely to undergo cesarean section (Table 1). Length of stay was significantly longer in women with CHD (2.6 ± 2.3 days for women without CHD, 3.4 ± 10.2 days for women with NC-CHD and 5.0 ± 13.3 days for women with C-CHD). In-hospital mortality was not significantly higher in women with CHD (Table 1). Incident heart failure, arrhythmias, and cardiac arrest were uncommon in all groups (Table 1). Conclusions: In this study of 2.7 million women admitted to California hospitals for delivery, women with CHD were more likely to undergo cesarean section and had longer length of stay. Despite more frequent history of CHF in women with CHD, incident CHF and arrhythmias were rare during hospitalization. In-hospital mortality and cardiac arrest were not higher in CHD patients. These results suggest that in pregnant women with CHD, cardiac events and mortality at the time delivery are uncommon.

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ACUTE KIDNEY INJURY, AS DEFINED BY THE RIFLE CRITERIA, IS ASSOCIATED WITH MORTALITY AND LENGTH OF STAY IN CHILDREN UNDERGOING SURGERY FOR CONGENITAL HEART DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)60450-6 ◽

2011 ◽

Vol 57 (14) ◽

pp. E450 ◽

Cited By ~ 1

Author(s):

Scott Aydin ◽

Howard Seiden ◽

Andrew Blaufox ◽

Vincent Parnell ◽

Tarif Choudhury ◽

...

Keyword(s):

Acute Kidney Injury ◽

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Kidney Injury ◽

Rifle Criteria

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Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

Pediatric Cardiology ◽

10.1007/s00246-015-1319-x ◽

2016 ◽

Vol 37 (3) ◽

pp. 593-600 ◽

Cited By ~ 10

Author(s):

Eric A. Johnson ◽

M. Mujeeb Zubair ◽

Laurie R. Armsby ◽

Grant H. Burch ◽

Milon K. Good ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Surgical Quality

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Life-threatening airway bleeding after palliation of single ventricle congenital heart disease

Heart ◽

10.1136/heartjnl-2017-311764 ◽

2017 ◽

Vol 104 (3) ◽

pp. 254-260 ◽

Cited By ~ 4

Author(s):

Konstantin Averin ◽

Jonathan W Byrnes ◽

Dan T Benscoter ◽

Wendy Whiteside ◽

Holly DeSena ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Single Ventricle ◽

Case Series ◽

Hospital Length Of Stay ◽

Interventional Bronchoscopy ◽

Cavopulmonary Anastomosis ◽

Life Threatening

ObjectiveTo describe acute and mid-term outcomes following presentation with, and treatment for, life-threatening airway bleeding (hemoptysis) in palliated single ventricle congenital heart disease (SV-CHD).MethodsCase series of patients with SV-CHD who presented to a large congenital heart centre with hemoptysis between 2004 and 2015.ResultsTwenty-one episodes of hemoptysis occurred in 12 patients (58% female, median 10.5 (IQR 7.2, 16.4) years). First hemoptysis episode occurred after Fontan completion (n=8), after superior cavopulmonary anastomosis (SCPA, n=3) and in one shunt-dependent patient. Bronchoscopy was performed in conjunction with catheterisation in 14/21 (67%) initial catheterisations. A specific anatomic source of airway bleeding was identified in 95% of bronchoscopy cases and was uniformly distributed in all lobar segments. Transcatheter intervention with systemic-to-pulmonary collateral artery (SPC) occlusion was performed in 28/30 catheterisations. Apart from increased airway bleeding during interventional bronchoscopy (37%), there were no procedural complications. Median hospital length of stay was 9.0 (3.5, 14.5) days with patients undergoing 1.0 (1.0,2.0) catheterisations per episode of hemoptysis. Two SCPA patients did not survive to discharge. During a median follow-up of 32.5 (12.5, 87.5) months, freedom from mortality was 75%, with all three deaths occurring in the SCPA group by 4 months posthemoptysis. Recurrent hemoptysis occurred in 60% of patients.ConclusionsDespite the potentially life-threatening nature of hemoptysis in patients with SV-CHD, a policy of bronchoscopic evaluation and transcatheter treatment is safe and may contribute to low mortality at mid-term follow-up in Fontan patients. Hemoptysis in SCPA patients may portend a poor prognosis. Recurrent hemoptysis is common.

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Evaluating the Use of Octreotide for Acquired Chylothorax in Pediatric Critically Ill Patients Following Cardiac Surgery

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.5.406 ◽

2019 ◽

Vol 24 (5) ◽

pp. 406-415

Author(s):

Annie Bui ◽

Courtney J. Long ◽

Robin L. Breitzka ◽

Joshua S. Wolovits

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Chest Tube ◽

Conventional Therapy ◽

Congenital Heart ◽

Pediatric Patients ◽

Therapy Group ◽

Final Analysis ◽

Hospital Length Of Stay ◽

The Impact

OBJECTIVES To evaluate the impact of octreotide on time to resolution of chylothorax compared with conventional therapy. Secondary outcomes include the following: time to reduction of chest tube output by 20%, additional surgeries for chylothorax, hospital length of stay, in-hospital mortality, and adverse drug reactions. METHODS We retrospectively evaluated the efficacy of octreotide vs conventional therapy for treatment postoperative chylothorax in pediatric patients in the cardiac ICU following surgery for congenital heart disease between October 2008 and June 2017. RESULTS Final analysis included 32 patients with chylothorax who met inclusion criteria. Patients who received octreotide had a longer duration of chest tube drainage than those who received conventional therapy (24 vs 9 days, p < 0.001). Resolution of chylothorax was achieved in 13 of 16 (81.3%) octreotide patients and 16 of 16 (100%) conventional patients (p = 0.178). There was a comparable time to reduction by 20% in drainage (6 vs 8 days, p = 0.337). There was no significant correlation between time after starting conventional management and reduction chylous output in either the octreotide or conventional therapy group (p = 0.809, p = 0.107, respectively). However, there was a significant and moderate correlation between octreotide and reduction in a chylous output following initiation of octreotide (R2 = 0.464, p = 0.021). CONCLUSIONS Octreotide is potentially a safe and effective therapy for treatment in pediatric patients with refractory chylothorax following surgery for congenital heart disease.

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Alpha-blockade during congenital heart surgery admissions: analysis from national database

Cardiology in the Young ◽

10.1017/s1047951121003875 ◽

2021 ◽

pp. 1-7

Author(s):

Brian Lee ◽

Enrique G. Villarreal ◽

Emad B. Mossad ◽

Jacqueline Rausa ◽

Ronald A. Bronicki ◽

...

Keyword(s):

Length Of Stay ◽

Congenital Heart ◽

Heart Surgery ◽

Univariate Analysis ◽

Congenital Heart Surgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Icu Length Of Stay ◽

Alpha Blockade ◽

Stay Hospital

Abstract Introduction: The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes. Materials and Methods: A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality. Results: Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges. Conclusions: Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.

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