Phrenic Nerve Injury Complicating Closed Cardiovascular Surgical Procedures for Congenital Heart Disease

Abstract Background Adults with congenital heart disease (ACHD) represent a growing patient population with high morbidity and increasing health resource utilization. In addition to acute and chronic cardiac complications, these patients require numerous non-cardiac surgical procedures during their life-time. Limited data on the morbidity and mortality risk related to non-cardiac surgical procedures exist in contemporary CHD patients. The aim of this study was to analyse the frequency and outcome of non-cardiac surgical procedures in contemporary ACHD patients based on all hospital admissions in Germany between 2011 and 2016. Methods Based on the German diagnosis related groups data of patients treated between 2011 and 2016 we identified all ACHD patients treated surgically as inpatients for non-cardiac problems. The dataset contains information on patient demographics, primary and secondary diagnoses, interventional or surgical procedures, duration of stay and outcome including mortality. The primary endpoint of the study was surgery related mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis or resuscitation). Results Overall, 48,872 ACHD cases were hospitalized during the study period. Of these, 20,450 (41.8%) were hospitalized for non-cardiac surgical procedures. The median age at surgery was 50.0 years and 62.9% of patients were male. The overall mortality rate following non-cardiac operations was 2.8% (95% CI 2.6–3.0%). The highest mortality rates were observed for procedure codes involving pharynx, larynx or trachea (27.2%; 95% CI: 22.3–32.1%) and lung surgery (15.4%; 95% CI: 13.3–17.8%). Abdominal surgery (9.2%; 95% CI: 7.7–10.9) and neurosurgical procedures (7.8%; 95% CI: 5.4–10.9) also had relative high mortality rates. The major adverse event rate overall was 12.7% (95% CI 11.7–12.7%). The highest major adverse event rates were observed for surgery of the airways (43.2%; 95% CI: 40.2%-46.4%). Conclusions Non-cardiac surgical procedures are common in ACHD patients and are associated with considerable mortality and morbidity in this cohort. Especially, surgical procedures involving the airways or neurosurgery emerged as risky procedures. However, even for routine abdominal or orthopaedic surgery considerable mortality and morbidity was observed. Overall, our data support careful pre-operative patient evaluation and concentration of surgical procedures at centres with extensive surgical and anaesthetic experience with ACHD patients.

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Anesthesia for Common Cardiac Lesions

10.2310/anes.18010 ◽

2018 ◽

Author(s):

Douglas Atkinson ◽

Viviane G Nasr

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Surgical Procedures ◽

Cardiac Disease ◽

Congenital Heart ◽

Preoperative Evaluation ◽

Venous Pressure ◽

Preoperative Assessment ◽

Catheterization Laboratory

Congenital heart disease is the most common congenital malformation with an incidence of 4 to 10 per 1,000 live births. Anesthesiologists are required to manage these patients when they present for surgical or percutaneous interventions, including definitive and/or palliative procedures. The preoperative evaluation of the cardiac patient includes a thorough physical examination, laboratory testing, and diagnostic imaging such as echocardiography and magnetic resonance imaging. The perioperative management of children with cardiac disease requires a thorough understanding of the underlying pathophysiology, invasive monitoring such as arterial pressure and central venous pressure, and different surgical procedures and interventions in the catheterization laboratory. In addition, understanding cardiopulmonary bypass including perfusion, temperature, and acid-base is a must. This chapter presents a systematic approach for the preoperative assessment of children with cardiac disease and management on cardiopulmonary bypass and discusses the different surgical procedures and catheterization laboratory interventions, indications, and potential complications. This review contains 1 figure, 9 tables, and 23 references. Key Words: associated anomalies, cardiac surgical procedures, cardiopulmonary bypass, congenital heart disease, intraoperative monitoring, inotropes, interventional catheterization, preoperative evaluation, vasodilators

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Variability in noncardiac surgical procedures in children with congenital heart disease

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2014.06.001 ◽

2014 ◽

Vol 49 (11) ◽

pp. 1564-1569 ◽

Cited By ~ 16

Author(s):

Jason P. Sulkowski ◽

Jennifer N. Cooper ◽

Patrick I. McConnell ◽

Sara K. Pasquali ◽

Samir S. Shah ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Surgical Procedures ◽

Congenital Heart

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German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2020—Comprehensive Data from 6 Years of Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1722978 ◽

2021 ◽

Vol 69 (S 03) ◽

pp. e21-e31

Author(s):

Andreas Beckmann ◽

S. Dittrich ◽

C. Arenz ◽

O.N. Krogmann ◽

A. Horke ◽

...

Keyword(s):

Congenital Heart Disease ◽

Quality Assurance ◽

Heart Disease ◽

Surgical Procedures ◽

Congenital Heart ◽

Interventional Procedures ◽

German Society ◽

Medical Quality ◽

German Registry ◽

Cardiac Operations

Abstract Background Based on a quality assurance initiative of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the German Society for Pediatric Cardiology and Congenital Heart Defects (DGPK), a voluntary registry was founded for assessment of treatment and outcomes of patients with congenital heart disease in Germany. This evaluation by the German Registry for cardiac operations and interventions in patients with congenital heart disease reports the data and the outcome over a 6-year period in patients undergoing invasive treatment. Methods This real-world database collects clinical characteristics, in-hospital complications, and medium-term outcome of patients who underwent cardiac surgical and interventional procedures within the prospective, all-comers registry. Patients were followed-up for up to 90 days. Results In the period from 2013 to 2018, a total of 35,730 patients, 39,875 cases, respectively 46,700 procedures were included at up to 31 German institutions. The cases could be subcategorized according to the treatment intention into 21,027 (52.7%) isolated operations, 17,259 (43.3%) isolated interventions, and 1,589 (4.0%) with multiple procedures. Of these, 4,708 (11.8%) were performed in neonates, 10,047 (25.2%) in infants, 19,351 (48.5%) in children of 1 to 18 years, and 5,769 (14.5%) in adults. Also, 15,845 (33.9%) cases could be allocated to so-called index procedures which underwent a more detailed evaluation to enable meaningful comparability. The mean unadjusted in-hospital mortality of all cases in our registry ranged from 0.3% in patients with isolated interventions and 2.0% in patients with surgical procedures up to 9.1% in patients undergoing multiple procedures. Conclusion This annually updated registry of both scientific societies represents voluntary public reporting by accumulating actual information for surgical and interventional procedures in patients with congenital heart disease (CHD) in Germany. It describes advancements in cardiac medicine and is a basis for internal and external quality assurance for all participating institutions. In addition, the registry demonstrates that in Germany, both interventional and surgical procedures for treatment of CHD are offered with high medical quality.

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Analysis of risk factors for dietary protein enterocolitis in congenital heart disease patients undergoing cardiac surgical procedures

Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology ◽

10.3388/jspaci.28.822 ◽

2014 ◽

Vol 28 (5) ◽

pp. 822-828

Author(s):

Sachiko Misumi ◽

Yasushi Akiba ◽

Akiko Yamaide ◽

Minako Tomiita ◽

Akira Hoshioka

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Surgical Procedures ◽

Dietary Protein ◽

Congenital Heart ◽

Cardiac Surgical Procedures

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Psychological functioning in parents of children undergoing elective cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951104002045 ◽

2004 ◽

Vol 14 (2) ◽

pp. 131-139 ◽

Cited By ~ 42

Author(s):

Jo Wray ◽

Tom Sensky

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Surgical Procedures ◽

Congenital Heart ◽

Individual Characteristics ◽

Hospital Treatment ◽

Healthy Children ◽

Elective Cardiac Surgery ◽

Over Time

Purpose: To assess levels of distress, the marital relationship, and styles of coping of parents of children with congenital heart disease, to evaluate any change in these parameters following elective cardiac surgery for their child, and to compare these parents with parents of children undergoing another form of hospital treatment, and with parents of healthy children.Design:A prospective study in which parents were assessed the day before the surgical procedure being undergone by their child, and 12 months afterwards.Participants:We assessed three groups of parents of 75 children, aged from birth to 16.9 years. The first was a group whose children were undergoing surgery because of congenital heart disease, the second was a group whose children were undergoing transplantation of bone marrow, and the third was a group whose children were healthy. Measures used for assessment included the General Health Questionnaire, the Dyadic adjustment scale, and the Utrecht coping list.Results:Parents in both groups of children undergoing surgery had significantly higher rates of distress prior to the surgical procedures than did the parents of the healthy children, but within those whose children were undergoing cardiac surgery, there were no differences between parents of children with cyanotic and acyanotic lesions. Following treatment, there was a significant reduction in the levels of distress in both groups whose children had undergone surgery. There were few differences between any of the groups on the other parameters, and the evaluated indexes showed stability over time.Conclusion:Despite elevated levels of psychological distress prior to surgical procedures, which had fallen after one year, the stability of other parameters of parental functioning over time suggests that the surgical interventions are of less significance than either factors attributable to the presence of chronic illness, or the individual characteristics of the parents.

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