Abstract 17042: Surgery and Outcomes for Transposition of the Great Arteries among Developing World Congenital Heart Surgery Programs: a Report from the International Quality Improvement Collaborative

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David N Schidlow ◽  
Kathy J Jenkins ◽  
Kimberlee Gauvreau ◽  
Ulisses A Croti ◽  
Do Thi Cam Giang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Hospital Mortality ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Developing World ◽  
Arterial Switch Operation ◽  
Institutional Characteristics ◽  
Quality Improvement Collaborative ◽  
Surgical Interventions

Objectives: Surgical care for CHD in the developing world is rapidly evolving, allowing an opportunity for survival for children with previously lethal conditions. Little information is available about such patients and their outcomes. The objectives of this study were to identify (1) patient characteristics, (2) surgical interventions, (3) institutional characteristics, and (4) risk factors for mortality among patients in the International Quality Improvement Collaborative (IQIC) undergoing surgery for transposition of the great arteries (TGA) with intact ventricular septum (IVS) and TGA with ventricular septal defect (VSD). Methods: We utilized a novel international collaborative database collected by developing world congenital heart surgical programs as part of a QI project. All TGA (IVS and VSD) cases from 2010-2012 were included. Demographic, surgical and institutional characteristics and their associations with in-hospital mortality were identified. Results: There were 559 patients at 21 centers who underwent surgery for TGA: 348 TGA/IVS and 211 TGA/VSD. TGA/IVS patients underwent arterial switch operation (ASO), 282 (81%); 2-stage ASO, 24 (7%); and atrial switch (ATS) 42, (12%). TGA/VSD patients underwent ASO, 169 (80%); 2-stage ASO, 19 (9%); and ATS, 23 (11%); all with VSD closure. In-hospital mortality ranged from 10% to 25% depending on procedure (Figure). Unadjusted mortality rates were higher among centers performing <10 TGA repairs yearly (OR 3.98; 95% CI 2.08-7.60, p<0.001). Among patients with TGA/IVS who underwent primary ASO, risk factors for mortality included male gender (p=0.05), weight <3 kg (p=0.04), and prematurity (p=0.007). Conclusions: Infants with TGA in the developing world increasingly have access to complex surgical repairs, and the majority of such patients undergo single-stage ASO. Mortality remains substantial; however, multi-center collaborative QI efforts are likely to benefit these patients.

Impact of International Quality Improvement Collaborative on Congenital Heart Surgery in Pakistan

Heart ◽  
2017 ◽  
Vol 103 (21) ◽  
pp. 1680-1686 ◽  
Author(s):  
Amina Khan ◽  
Ahmed Abdullah ◽  
Huzaifa Ahmad ◽  
Arjumand Rizvi ◽  
Sehrish Batool ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Quality Improvement Collaborative

Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

2014 ◽  
Vol 25 (5) ◽  
pp. 935-940 ◽  
Author(s):  
Brian Kogon ◽  
Kim Woodall ◽  
Kirk Kanter ◽  
Bahaaldin Alsoufi ◽  
Matt Oster
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Failure To Thrive ◽  
Congenital Heart Surgery ◽  
Cardiothoracic Surgery ◽  
Hispanic Ethnicity ◽  
Multivariate Risk ◽  
Initial Hospital

AbstractBackground: We have previously identified risk factors for readmission following congenital heart surgery – Hispanic ethnicity, failure to thrive, and original hospital stay more than 10 days. As part of a quality initiative, changes were made to the discharge process in hopes of reducing the impact. All discharges were carried out with an interpreter, medications were delivered to the hospital before discharge, and phone calls were made to families within 72 hours following discharge. We hypothesised that these changes would decrease readmissions. Methods: The current cohort of 635 patients underwent surgery in 2012. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate and multivariate risk factor analyses were performed. Comparisons were made between the initial (2009) and the current (2012) cohorts. Results: There were 86 readmissions of 77 patients during 2012. Multivariate risk factors for readmission were risk adjustment for congenital heart surgery score and initial hospital stay >10 days. In comparing 2009 with 2012, the overall readmission rate was similar (10 versus 12%, p=0.27). Although there were slight decreases in the 2012 readmissions for those patients with Hispanic ethnicity (18 versus 16%, p=0.79), failure to thrive (23 versus 17%, p=0.49), and initial hospital stay >10 days (22 versus 20%, p=0.63), they were not statistically significant. Conclusions: Potential risk factors for readmission following paediatric cardiothoracic surgery have been identified. Although targeted modifications in discharge processes can be made, they may not reduce readmissions. Efforts should continue to identify modifiable factors that can reduce the negative impact of hospital readmissions.

Analysis of regional congenital cardiac surgical outcomes in Florida using The Society of Thoracic Surgeons Congenital Heart Surgery Database

2009 ◽  
Vol 19 (4) ◽  
pp. 360-369 ◽  
Author(s):  
Jeffrey P. Jacobs ◽  
James A. Quintessenza ◽  
Redmond P. Burke ◽  
Mark S. Bleiweis ◽  
Barry J. Byrne ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Regional Analysis ◽  
The United States ◽  
Congenital Heart Surgery ◽  
Medical Services ◽  
Congenital Cardiac Surgery ◽  
Children's Medical Services

AbstractBackgroundFlorida is the fourth largest state in the United States of America. In 2004, 218,045 live babies were born in Florida, accounting for approximately 1744 new cases of congenital heart disease. We review the initial experience of The Society of Thoracic Surgeons Congenital Heart Surgery Database with a regional outcomes report, namely the Society of Thoracic Surgeons Florida Regional Report.MethodsEight centres in Florida provide services for congenital cardiac surgery. The Children’s Medical Services of Florida provide a framework for quality improvement collaboration between centres. All congenital cardiac surgical centres in Florida have voluntarily agreed to submit data to the Society of Thoracic Surgeons Database. The Society of Thoracic Surgeons and Duke Clinical Research Institute prepared a Florida Regional Report to allow detailed regional analysis of outcomes for congenital cardiac surgery.ResultsThe report of 2007 from the Society of Thoracic Surgeons Congenital Heart Surgery Database includes details of 61,014 operations performed during the 4 year data harvest window, which extended from 2003 through 2006. Of these operations, 6,385 (10.5%) were performed in Florida. Discharge mortality in the data from Florida overall, and from each Florida site, with 95% confidence intervals, is not different from cumulative data from the entire Society of Thoracic Surgeons Database, both for all patients and for patients stratified by complexity.ConclusionsA regional consortium of congenital heart surgery centres in Florida under the framework of the Children’s Medical Services has allowed for inter-institutional collaboration with the goal of quality improvement. This experience demonstrates, first, that the database maintained by the Society of Thoracic Surgeons can provide the framework for regional analysis of outcomes, and second, that voluntary regional collaborative efforts permit the pooling of data for such analysis.

Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies

2020 ◽  
Vol 40 (1) ◽  
pp. 46-55
Author(s):  
Kirsti G. Catton ◽  
Jennifer K. Peterson
Keyword(s):  
Risk Factors ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Early Recognition ◽  
Treatment Options ◽  
Age Groups ◽  
Atrioventricular Node ◽  
Congenital Heart Surgery ◽  
Junctional Ectopic Tachycardia ◽  
Perioperative Morbidity

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

scholarly journals IMPACT Registry and National Pediatric Cardiology Quality Improvement Collaborative: Contributions to Quality in Congenital Heart Disease

2019 ◽  
Vol 10 (1) ◽  
pp. 72-80 ◽  
Author(s):  
Gerard R. Martin ◽  
Jeffrey B. Anderson ◽  
Robert N. Vincent
Keyword(s):  
Congenital Heart Disease ◽  
Quality Improvement ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pediatric Cardiology ◽  
Device Closure ◽  
Stent Angioplasty ◽  
Quality Improvement Collaborative ◽  
The Common ◽  
The Impact

The IMproving Pediatric and Adult Congenital Treatments (IMPACT) Registry and the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) are two efforts initiated to improve outcomes in the congenital heart disease field. The IMPACT Registry is focused on evaluating the use, risks, adverse events (AEs), and outcomes associated with diagnostic and common interventional catheterization procedures in all children and adults with congenital heart disease. Utilizing a modular approach, the common procedures include diagnostic cardiac catheterization, atrial septal defect device closure, patent ductus arteriosus device closure, pulmonary valvuloplasty, aortic valvuloplasty, balloon and stent angioplasty of coarctation of the aorta, pulmonary artery balloon stent angioplasty, transcatheter pulmonary valve replacement, and electrophysiology procedures including radiofrequency ablation. To date, important observations on the common procedures have been made and a risk stratification methodology has been created to allow comparisons between centers in AEs and quality improvement activity. The registry is open to international participation. The NPC-QIC was developed to reduce mortality and improve the quality of life of infants with Hypoplastic Left Heart Syndrome (HLHS) during the interstage period between discharge from the Norwood operation and admission for the bidirectional Glenn procedure. Mortality in the interstage has been reduced by 44%. The IMPACT Registry and the NPC-QIC have demonstrated value to the congenital heart disease community. The IMPACT Registry, however, has not yet demonstrated an impact on patient outcomes. The NPC-QIC, which combines both a registry with a learning collaborative with specific aims, key drivers, and change strategies, has made more significant gains with reductions in variation, growth failures, and mortality.

Risk Factors for In-Hospital Mortality During Infective Endocarditis in Patients With Congenital Heart Disease

2008 ◽  
Vol 101 (1) ◽  
pp. 114-118 ◽  
Author(s):  
Masao Yoshinaga ◽  
Koichiro Niwa ◽  
Atsuko Niwa ◽  
Naruhiko Ishiwada ◽  
Hideto Takahashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Congenital Heart
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