Perioperative Outcomes in Children with Congenital Heart Disease when cared for by a Congenital Cardiac Anesthesiologist during Noncardiac Surgery

2021 ◽  
pp. 100194
Author(s):  
Chinwe Unegbu ◽  
Jaisree Iyer ◽  
Marni Jacobs ◽  
Nina Deutsch ◽  
Andrew Matisoff
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Noncardiac Surgery ◽  
Perioperative Outcomes

Perioperative Outcomes of Major Noncardiac Surgery in Adults With Congenital Heart Disease

2014 ◽  
Vol 58 (3) ◽  
pp. 103-104
Author(s):  
Bryan G. Maxwell ◽  
Jim K. Wong ◽  
Cindy Kin ◽  
Robert L. Lobato
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Noncardiac Surgery ◽  
Perioperative Outcomes

scholarly journals Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

2013 ◽  
Vol 119 (4) ◽  
pp. 762-769 ◽  
Author(s):  
Bryan G. Maxwell ◽  
Jim K. Wong ◽  
Cindy Kin ◽  
Robert L. Lobato
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Odds Ratio ◽  
Congenital Heart ◽  
Noncardiac Surgery ◽  
Perioperative Outcomes ◽  
P Value ◽  
Perioperative Morbidity ◽  
Number Of Patients ◽  
Comparison Cohort

Abstract Background: An increasing number of patients with congenital heart disease are surviving to adulthood. Consensus guidelines and expert opinion suggest that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population. Methods: By using the Nationwide Inpatient Sample database (years 2002 through 2009), the authors compared patients with adult congenital heart disease (ACHD) who underwent noncardiac surgery with a non-ACHD comparison cohort matched on age, sex, race, year, elective or urgent or emergency procedure, van Walraven comborbidity score, and primary procedure code. Mortality and morbidity were compared between the two cohorts. Results: A study cohort consisting of 10,004 ACHD patients was compared with a matched comparison cohort of 37,581 patients. Inpatient mortality was greater in the ACHD cohort (407 of 10,004 [4.1%] vs. 1,355 of 37,581 [3.6%]; unadjusted odds ratio, 1.13; P = 0.031; adjusted odds ratio, 1.29; P < 0.001). The composite endpoint of perioperative morbidity was also more commonly observed in the ACHD cohort (2,145 of 10.004 [21.4%] vs. 6,003 of 37,581 [16.0%]; odds ratio, 1.44; P < 0.001). ACHD patients comprised an increasing proportion of all noncardiac surgical admissions over the study period (P value for trend is <0.001), and noncardiac surgery represented an increasing proportion of all ACHD admissions (P value for trend is <0.001). Conclusions: Compared with a matched control cohort, ACHD patients undergoing noncardiac surgery experienced increased perioperative morbidity and mortality. Within the limitations of a retrospective analysis of a large administrative dataset, this finding demonstrates that this is a vulnerable population and suggests that better efforts are needed to understand and improve the perioperative care they receive.

scholarly journals Assessing the Risks of Noncardiac Surgery for Children With Congenital Heart Disease∗

2016 ◽  
Vol 67 (7) ◽  
pp. 802-803 ◽  
Author(s):  
Claudia Benkwitz ◽  
Scott C. Watkins ◽  
Brian S. Donahue
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Noncardiac Surgery

Management of Children with Congenital Heart Disease for Noncardiac Surgery

2018 ◽  
Author(s):  
Dean B. Andropoulos
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Systematic Approach ◽  
Preoperative Evaluation ◽  
Noncardiac Surgery ◽  
Inotropic Support ◽  
Surgical Approaches ◽  
Endocarditis Prophylaxis ◽  
Anesthetic Complications

Congenital heart disease (CHD) patients are increasingly presenting for noncardiac surgery, and the anesthesiologist must possess an understanding of the major classes of CHD and their pathophysiology, as well as surgical approaches for correction or palliation. A thorough preoperative evaluation and anesthetic plan, including invasive monitoring, inotropic support, blood transfusion, endocarditis prophylaxis, pacemaker/defibrillator functioning, and intensive care unit admission must be developed, and include a multidisciplinary team. Each patient has a unique pathophysiology and a systematic approach to understanding hemodynamic consequences, and developing hemodynamic goals for the anesthetic will improve the potential to minimize anesthetic complications and ensure the best possible outcomes.

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