Outcomes for unplanned reinterventions following paediatric cardiac surgery for tetralogy of Fallot

2021 ◽  
pp. 1-6
Author(s):  
Asaad G. Beshish ◽  
Elizabeth B. Aronoff ◽  
Nikita Rao ◽  
Mohua Basu ◽  
Tawanda Zinyandu ◽  
...  

Abstract Background: Advances in surgical techniques and post-operative management of children with CHD have significantly lowered mortality rates. Unplanned cardiac interventions are a significant complication with implications on morbidity and mortality. Methods: We conducted a single-centre retrospective case–control study for patients (<18 years) undergoing cardiac surgery for repair of Tetralogy of Fallot between January 2009 and December 2019. Data included patient characteristics, operative variables and outcomes. This study aimed to assess the incidence and risk factors for reintervention of Tetralogy of Fallot after cardiac surgery. The secondary outcome was to examine the incidence of long-term morbidity and mortality in those who underwent unplanned reinterventions. Results: During the study period 29 patients (6.8%) underwent unplanned reintervention, and were matched to 58 patients by age, weight and sex. Median age was 146 days, and median weight was 5.8 kg. Operative mortality was 7%, and 1-year survival was 86% for the entire cohort (cases and controls). Hispanic patients were more likely to have reinterventions (p = 0.04) in the unadjusted analysis, while Asian, Pacific Islander and Native American (p = 0.01) in the multi-variate analysis. Patients that underwent reintervention were more likely to have post-op arrhythmia, genetic syndromes and higher operative and 1-year mortality (p < 0.05). Conclusion: Unplanned cardiac interventions following Tetralogy of Fallot repair are common, and associated with increased operative, and 1-year mortality. Race, genetic syndromes and post-operative arrhythmia are associated with increased odds of unplanned reinterventions. Future studies are needed to identify modifiable risk factors to minimise unplanned reinterventions.

2020 ◽  
Vol 30 (6) ◽  
pp. 761-768
Author(s):  
Daniel M. Pasternack ◽  
Manal AlQahtani ◽  
Rafael Zonana Amkie ◽  
Lisa J. Sosa ◽  
Marcelle Reyes ◽  
...  

AbstractIntroduction:Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.Materials and methods:In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.Results:We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89–13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34–7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69–13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02–7.97, p = 0.005), which were independent of other risk factors.Discussion:We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.


Author(s):  
Alfred Ibrahimi ◽  
Saimir Kuçi ◽  
Ervin Bejko ◽  
Stavri Llazo ◽  
Jonela Burimi ◽  
...  

Purpose: gastrointestinal complication (GIC) following open heart surgery usually are rare but with high morbidity and mortality. The aim of this study was to see the outcome of these patients after complication, compared with a similar study found in literature. Identifying risk factors preoperatively and postoperatively in our patient’s series, for GIC.Materials and methods: Between January 2012 and December 2017 from 1990 operated cardiac patient 34 of them developed GIC, presenting gastro duodenal bleeding due to active ulcer, liver failure, pancreatitis, cholecystitis, or intestinal ischemia. We performed a retrospective analysis.Results: From all consecutive patient only 1.7 % developed GIC. Mortality rate was 55.8%, especially 100 % mortality in intestinal ischemia patient. Regarding risk factors, those were the same found in other similar study (age, atherosclerosis disease, by pass time, postoperative ARF, Low cardiac output syndrome.)Conclusion: GIC after cardiac surgery are rare but when it happens the mortality is very high not even of late diagnosis. In ages patients, diabetes, long by pass time, long hypoperfusion state. It is recommended to be alert for GIC for detection in early phase, and for reducing as much as possible morbidity and mortality.


BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045052
Author(s):  
Ana Belen Serrano ◽  
Maria Gomez-Rojo ◽  
Eva Ureta ◽  
Monica Nuñez ◽  
Borja Fernández Félix ◽  
...  

ObjectivesTo determine preoperative factors associated to myocardial injury after non-cardiac surgery (MINS) and to develop a prediction model of MINS.DesignRetrospective analysis.SettingTertiary hospital in Spain.ParticipantsPatients aged ≥45 years undergoing major non-cardiac surgery and with at least two measures of troponin levels within the first 3 days of the postoperative period. All patients were screened for the MANAGE trial.Primary and secondary outcome measuresWe used multivariable logistic regression analysis to study risk factors associated with MINS and created a score predicting the preoperative risk for MINS and a nomogram to facilitate bed-side use. We used Least Absolute Shrinkage and Selection Operator method to choose the factors included in the predictive model with MINS as dependent variable. The predictive ability of the model was evaluated. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC) and calibration was visually assessed using calibration plots representing deciles of predicted probability of MINS against the observed rate in each risk group and the calibration-in-the-large (CITL) and the calibration slope. We created a nomogram to facilitate obtaining risk estimates for patients at pre-anaesthesia evaluation.ResultsOur cohort included 3633 patients recruited from 9 September 2014 to 17 July 2017. The incidence of MINS was 9%. Preoperative risk factors that increased the risk of MINS were age, American Status Anaesthesiology classification and vascular surgery. The predictive model showed good performance in terms of discrimination (AUC=0.720; 95% CI: 0.69 to 0.75) and calibration slope=1.043 (95% CI: 0.90 to 1.18) and CITL=0.00 (95% CI: −0.12 to 0.12).ConclusionsOur predictive model based on routinely preoperative information is highly affordable and might be a useful tool to identify moderate-high risk patients before surgery. However, external validation is needed before implementation.


2021 ◽  
pp. 1-6
Author(s):  
Eleonore Valencia ◽  
Steven J. Staffa ◽  
Meena Nathan ◽  
Melissa Smith-Parrish ◽  
Aditya K. Kaza ◽  
...  

Abstract Objective: To evaluate the discriminative ability of hyperlactataemia for early morbidity and mortality in neonates with CHD following cardiac surgery. Methods: Retrospective, observational study of neonates who underwent cardiac surgery on cardiopulmonary bypass at a tertiary care children’s hospital from June 2015 to June 2019. The primary predictor was lactate. The primary composite outcome was defined as ≥1 of the following: cardiac arrest or extracorporeal membrane oxygenation within 72 hours or 30-day mortality post-operatively. The secondary outcome was the presence of major residual lesions, according to the Technical Performance Score. Results: Of 432 neonates, 28 (6.5%) sustained the composite outcome. On univariate analysis, peak lactate within 48 hours, increase in lactate from ICU admission through 12 hours, and single ventricle physiology were significantly associated with the composite outcome. The peak lactate occurred at a median of 2.9 hours (interquartile range: 1, 35) before the event. Through multi-variable analysis, a multi-variable risk algorithm was created. Predicted probabilities demonstrated an increasing risk based on single ventricle status and delta lactate, ranging from 1.8% (95% CI: 0.9, 3.9) to 52.4% (95% CI: 32.4, 71.7). The model had good discriminative ability for the composite outcome on receiver operating characteristic analysis (area under the curve = 0.79; 95% CI: 0.75, 0.89). Moreover, a peak lactate of 7.3 mmol/l or greater was significantly associated with the presence of a major residual lesion (odds ratios: 5.16, 95% CI: 3.01, 8.87). Conclusions: We present a simple, two-variable model, including delta lactate in the immediate post-operative period and single ventricle status, to prognosticate the risk of early morbidity and mortality in neonates undergoing cardiac surgery for potential intervention.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmed Abdelrahman Elassal ◽  
Khalid Ebrahim Al-Ebrahim ◽  
Ragab Shehata Debis ◽  
Ehab Sobhy Ragab ◽  
Mazen Shamsaldeen Faden ◽  
...  

Abstract Background Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. Objective To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. Methods Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. Results Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality. Conclusion Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.


2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Ricardo Yuji Abe ◽  
Carla Melo Tavares ◽  
Rui Barroso Schimiti ◽  
José Paulo Cabral Vasconcellos ◽  
Vital Paulino Costa

Purpose. To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) implantation in patients with refractory glaucoma in a tertiary hospital in Brazil.Methods. Retrospective case series of patients who underwent AGV implantation. Primary outcome was to assess the rate of failure, which was defined as intraocular pressure (IOP) in two consecutive visits greater than 18 or lower than 5 mmHg (criterion 1) or IOP greater than 15 or lower than 5 mmHg (criterion 2). The secondary outcome was to investigate risk factors for failure.Results. 112 eyes from 108 patients underwent AGV implantation between 2000 and 2012. Mean follow-up time was 2.54 (±1.52) years. Kaplan-Meier survival analysis showed cumulative probabilities of success of 80.3%, 68.2%, and 47.3% at 1, 3, and 5 years using 18 mmHg as endpoint. When adopting 15 mmHg as endpoint, cumulative success rates were 80.3%, 60.7%, and 27.3% at 1, 3, and 5 years, respectively. Multivariate analysis with generalized estimating equations revealed that African American ancestry and early hypertensive phase were risk factors for failure (P=0.001andP=0.002, resp.).Conclusion. A success rate of approximately 50% was obtained 5 years after the implantation of an AGV. African American ancestry and early hypertensive phase were associated with increased risk of failure.


2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Giuseppe Maria Raffa ◽  
Francesco Agnello ◽  
Giovanna Occhipinti ◽  
Roberto Miraglia ◽  
Vincenzina Lo Re ◽  
...  

2018 ◽  
Vol 32 (2) ◽  
pp. 366-376
Author(s):  
Sachidanand Gautam ◽  
Ojha Piyush ◽  
Sharma Anubhav

Abstract Background: Extensive surgical resection remains nowadays the best treatment available for most brain tumours. Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. The goal of this study was to review the results of surgical treatment in our Department, run by a single neurosurgeon, in order to quantify morbidity and mortality and determine predictive risk factors for each patient. Materials and Methods: A total of Three hundred patients undergoing various surgeries for brain tumors were analyzed. Routine surgical techniques and uniform antibiotic policy were used. Navigation advanced operating microscope/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinicoepidemiological factors, tumor-related factors, and surgery-related factors. Results: Median age was 36.37 years. 74.3% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 14.3, 14.3, and 11.3%, respectively. Overall, major morbidity occurred in 14.3% and perioperative mortality rate was 3.3%. Conclusions: Our patients were younger and had larger tumors than were generally reported. Despite the unavailability of advanced intraoperative aids, we could achieve acceptable levels of morbidity and mortality rates. The knowledge of the complications rate in each particular neurosurgical department turns out essentially to provide the patient with tailored information about risks before surgery.


2021 ◽  
Vol 19 (2) ◽  
pp. 156-163
Author(s):  
H. Stoev

Introduction. Median sternotomy represents a standard surgical access in cardiac surgery, despite the growing popularity of minimally invasive access. Posternotomy infections are a serious complication and are directly related to patients' survival in the short and long term. Despite prevention, their expression is still significant - from 0.5% to 6.8%, and associated hospital mortality rates range from 7% to 35%. Aims. Analysis of frequency, risk factors, microbiological agents, prevention options and surgical techniques for deep wound infections after open heart surgery for a 17 - year period. Materials and methods. For the period from October 2002 to June 2019, 146 (1.42% of 10,307 operated) patients were treated at the Cardiac Surgery Clinic at the University Hospital “St. Georgi "diagnosed with deep sternal infection. The study is a retrospective using data from medical records and hospital records. The Center of Disease Control (CDC) criteria were used to define deep sternal infections. Results. The sex ratio is 2.04: 1 – men: women. The average age for both sexes is 65.4 years. The average stay of patients in the intensive care unit was 5 days (from 0 to 46 days), and the average total hospital stay was 15.6 days (from 5 to 55 days). Early postoperative mortality was 13,7%. The most common risk factors were diabetes mellitus, obesity and emergency surgery. Conclusion. Cardiac surgery with total midline sternotomy is associated with a risk of developing mediastinitis. Despite the advances in cardiac surgery and the use of mini-invasive techniques, the rate of development of deep wound infections remains relatively high.


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