Introduction and epidemiology

ESC CardioMed ◽  
2018 ◽  
pp. 2637-2639
Author(s):  
Hans Erik Bøtker
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Surgical Procedure ◽  
Congenital Heart ◽  
Perioperative Complications ◽  
Left Ventricular ◽  
Medical Attention ◽  
Cardiac Complications ◽  
Postoperative Risk ◽  
Number Of Patients

Perioperative complications during non-cardiac surgery depend on the condition of the patient prior to surgery, the prevalence of co-morbidities, and the magnitude, duration, and timing of the surgical procedure. Cardiac complications most frequently arise in patients with documented or asymptomatic ischaemic heart disease, left ventricular dysfunction, valvular heart disease, and arrhythmias, including the presence of a pacemaker or implantable cardioverter defibrillator, when they undergo surgical procedures that are associated with prolonged haemodynamic and cardiac stress. The increasing ageing of the population has a major impact on perioperative patient management. The number of elderly patients with co-morbidities undergoing surgery increases and new surgical and anaesthesia techniques allow surgeons to operate on patients who were previously declined. In addition, the life expectancy of children with congenital heart disease has improved. Hence, this population increasingly seeks medical attention for other illnesses, adding a rising number of patients who will undergo non-cardiac surgeries. Reduction of peri- and postoperative risk in relation to non-cardiac surgery requires a practical, stepwise evaluation of the patient that integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure.

Congenital heart disease in adults

2015 ◽  
Author(s):  
Susanna Price ◽  
Brian F Keogh ◽  
Lorna Swan
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Disease Patient ◽  
Expert Advice ◽  
Clinical State ◽  
Medical Attention ◽  
Physiological Status ◽  
Number Of Patients

The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.

Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease

2016 ◽  
Vol 27 (6) ◽  
pp. 1068-1075 ◽  
Author(s):  
David M. Kwiatkowski ◽  
Elizabeth Price ◽  
David M. Axelrod ◽  
Anitra W. Romfh ◽  
Brian S. Han ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Kidney Injury ◽  
Congenital Heart Surgery ◽  
Left Ventricular

AbstractBackgroundAcute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes.MethodsThis single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013.ResultsData from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis.ConclusionsWe demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.

Congenital heart disease in adults

2016 ◽  
Author(s):  
Susanna Price ◽  
Brian F Keogh ◽  
Lorna Swan
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Disease Patient ◽  
Expert Advice ◽  
Clinical State ◽  
Medical Attention ◽  
Physiological Status ◽  
Number Of Patients

The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.

scholarly journals Surgery for Adult Patients with Congenital Heart Disease: Results from the European Database

2020 ◽  
Vol 9 (8) ◽  
pp. 2493
Author(s):  
Vladimiro Vida ◽  
Lorenza Zanotto ◽  
Laura Torlai Triglia ◽  
Lucia Zanotto ◽  
Bohdan Maruszewski ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Patients ◽  
Left Heart ◽  
Septal Defects ◽  
Number Of Patients ◽  
Heart Lesions ◽  
Over Time

Adults with congenital heart disease (ACHD) represent a growing population. To evaluate frequency, type and outcomes of cardiac surgery in ACHD, we gathered data from the European Congenital Heart Surgeons Association Database of 20,602 adult patients (≥18 years) with a diagnosis of congenital heart disease who underwent cardiac surgery, between January 1997 and December 2017. We demonstrated that overall surgical workload (as absolute frequencies of surgical procedures per year) for this specific subset of patients increased steadily during the study period. The most common procedural groups included septal defects repair (n = 5740, 28%), right-heart lesions repair (n = 5542, 27%) and left-heart lesions repair (n = 4566, 22%); almost one-third of the procedures were re-operations (n = 5509, 27%). When considering the year-by-year relative frequencies of the main procedural groups, we observed a variation of the surgical scenario during the last two decades, characterized by a significant increase over time for right and left-heart lesions repair (p < 0.0001, both); while a significant decrease was seen for septal defects repair (p < 0.0001) and transplant (p = 0.03). Overall hospital mortality was 3% (n = 622/20,602 patients) and was stable over time. An inverse relationship between mortality and the number of patients operated in each center (p < 0.0001) was observed.

scholarly journals Cardiac Complications and Mortality Rates in Diabetic Patients following Non-cardiac Surgery in an Australian Teaching Hospital

2009 ◽  
Vol 37 (4) ◽  
pp. 561-567 ◽  
Author(s):  
S. N. C. Bolsin ◽  
F. Raineri ◽  
S. K. Lo ◽  
C. Cattigan ◽  
R. Arblaster ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Surgery ◽  
Perioperative Complications ◽  
Cardiac Complications ◽  
Published Data ◽  
Diabetic Patients ◽  
Number Of Patients ◽  
Increased Risk ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic

This retrospective study of diabetic patients undergoing non-cardiac surgery has identified that a greater number of patients are at risk of cardiac complications and death in the perioperative period than had previously been suggested. As well as insulin-dependent diabetic patients and patients with elevated creatinine (>178 μmol/l) as previously found, our study suggests that non-insulin-dependent diabetic patients and patients with creatinine >120 μmol/l are also at increased risk of cardiac complications and death following non-cardiac surgery. This increases by a factor of six those diabetic patients at risk of perioperative complications from non-cardiac surgery and also increases the number of patients with renal failure similarly at risk. The study confirms similar risks of cardiac complications and death to other recently published data and suggests ongoing comparisons will contribute to quality assurance activities in anaesthesia and surgery.

scholarly journals Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoqiang Yin ◽  
Mei Xin ◽  
Sheng Ding ◽  
Feng Gao ◽  
Fan Wu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arterial ◽  
Mechanical Ventilation Time

Abstract Background We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. Methods A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. Results We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). Conclusion For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.

scholarly journals Is alternative cardiac surgery an option in adults with congenital heart disease referred for thoracic organ transplantation?†

2012 ◽  
Vol 43 (2) ◽  
pp. 344-351 ◽  
Author(s):  
Andrew Robert Harper ◽  
David Steven Crossland ◽  
Gianluigi Perri ◽  
John Jude O'Sullivan ◽  
Milind Pralhad Chaudhari ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Organ Transplantation ◽  
Congenital Heart ◽  
Thoracic Organ

scholarly journals Down syndrome and congenital heart disease: perioperative planning and management

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Dennis R. Delany ◽  
Stephanie S. Gaydos ◽  
Deborah A. Romeo ◽  
Heather T. Henderson ◽  
Kristi L. Fogg ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Down Syndrome ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Single Ventricle ◽  
Heart Defects ◽  
Careful Consideration ◽  
Children With Down Syndrome ◽  
Perioperative Planning

AbstractApproximately 50% of newborns with Down syndrome have congenital heart disease. Non-cardiac comorbidities may also be present. Many of the principles and strategies of perioperative evaluation and management for patients with congenital heart disease apply to those with Down syndrome. Nevertheless, careful planning for cardiac surgery is required, evaluating for both cardiac and noncardiac disease, with careful consideration of the risk for pulmonary hypertension. In this manuscript, for children with Down syndrome and hemodynamically significant congenital heart disease, we will summarize the epidemiology of heart defects that warrant intervention. We will review perioperative planning for this unique population, including anesthetic considerations, common postoperative issues, nutritional strategies, and discharge planning. Special considerations for single ventricle palliation and heart transplantation evaluation will also be discussed. Overall, the risk of mortality with cardiac surgery in pediatric patients with Down syndrome is no more than the general population, except for those with functional single ventricle heart defects. Underlying comorbidities may contribute to postoperative complications and increased length of stay. A strong understanding of cardiac and non-cardiac considerations in children with Down syndrome will help clinicians optimize perioperative care and long-term outcomes.

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