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

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.

P4697Complications and mortality related to non-cardiac surgery in adult congenital heart disease: Results of a nationwide study including 20,450 cases

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G P Diller ◽  
E Freisinger ◽  
L Bronstein ◽  
J Koeppe ◽  
J Gerss ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Adverse Event ◽  
Heart Disease ◽  
Surgical Procedures ◽  
Congenital Heart ◽  
Cardiac Surgical Procedures ◽  
Mortality Rates ◽  
Adverse Event Rate ◽  
Major Adverse Event ◽  
Mortality And Morbidity

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.

scholarly journals Newborn Screening Pulse Oximetry to Detect Critical Congenital Heart Disease: A Follow-Up Survey of Current Practice at Army, Navy and Air Force Hospitals

2019 ◽  
Vol 184 (11-12) ◽  
pp. 826-831
Author(s):  
David L Robinson ◽  
Mark S Craig ◽  
Ronald S Wells ◽  
Kirk N Liesemer ◽  
Matthew A Studer
Keyword(s):  
Congenital Heart Disease ◽  
Quality Assurance ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Air Force ◽  
Congenital Heart ◽  
The United States ◽  
P Value ◽  
Critical Congenital Heart Disease

Abstract Introduction The purpose of this study was to assess the evolution of newborn pulse oximetry screening (+POx) among Army, Air Force, and Naval military hospitals (MH), including prevalence, protocol use, quality assurance processes, access to echocardiography, and use of telemedicine. This is a follow-up from a prior study published in 2011. Materials and Methods An Internet-based questionnaire was forwarded to the chief pediatrician at MH worldwide which support newborn deliveries. Descriptive data were reported using percentages. Grouped responses, as applicable, were further compared using the chi-square test. A p-value < 0.05 was considered statistically significant. Results Seventy-eight percent (36/46) of MH supporting deliveries worldwide responded to the survey (17 Army hospitals, 11 Navy Hospitals, 8 Air Force hospitals). All responding hospitals utilize +POx, of which 94% endorsed protocol compliance with the American Academy of Pediatrics guidelines. Nine (25%) hospitals were located outside of the United States. Delivery volumes (infants per month) range between 1–49 (36%), 50–99 (28%), 100–199 (19%), and 200–300 (17%). Eleven hospitals reported regular review of +POx data, with most reviewing them monthly. Four MH share findings with state institutions. Ten hospitals either have a staff pediatric cardiologist or use tele-echocardiography for on-site evaluations. Ten hospitals are located greater than 60 miles from the nearest center with echocardiography capabilities. Of the five hospitals using tele-echocardiography, four confirmed critical congenital heart disease (CCHD) using this practice, and all five reported averting transfer of an infant using this technology. Of the 22 hospitals lacking the ability to obtain on-site echocardiography, 12 (55%) are interested in implementing a tele-echocardiography protocol. Conclusions All responding MH use +POx, representing significant increase from the 30% of MH reporting use of +POx seven years ago. The majority of MH follow AAP +POx guidelines, and though most have providers review results prior to discharge, only one-third report periodic chart review for quality assurance. Most MH transfer infants with positive +POx results for evaluation due to a lack of on-site echocardiography. Tele-echocardiography was reported as a potential solution to diagnose or rule out CCHD. Over half of remaining hospitals without cardiologists are interested in using this technology to evaluate stable infants with positive CCHD screening.

scholarly journals Delayed Sternal Closure after Cardiac Operations for Congenital Heart Disease in Infancy.

1997 ◽  
Vol 26 (4) ◽  
pp. 224-229
Author(s):  
Toru Sato ◽  
Ken-ichi Kosuga ◽  
Munetaka Kumate ◽  
Tadashi Isomura ◽  
Shigeaki Aoyagi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Cardiac Operations

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

1985 ◽  
Vol 39 (5) ◽  
pp. 445-449 ◽  
Author(s):  
Zhao Hong-Xu ◽  
Richard S. D'Agostino ◽  
Paul T. Pitlick ◽  
Norman E. Shumway ◽  
D. Craig Miller
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Nerve Injury ◽  
Surgical Procedures ◽  
Phrenic Nerve ◽  
Congenital Heart ◽  
Phrenic Nerve Injury ◽  
Cardiovascular Surgical Procedures

Anesthesia for Common Cardiac Lesions

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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