Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

Background: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. Methods: Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. Results: In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. Conclusions: Resternotomy in pediatric cardiac surgery is a safe procedure in our center.

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

Cardiology in the Young ◽

10.1017/s1047951116002067 ◽

2016 ◽

Vol 27 (6) ◽

pp. 1068-1075 ◽

Cited By ~ 10

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.

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Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Cardiology in the Young ◽

10.1017/s1047951119002671 ◽

2019 ◽

Vol 30 (1) ◽

pp. 62-65 ◽

Cited By ~ 3

Author(s):

Cortney B. Foster ◽

Antonio G. Cabrera ◽

Dayanand Bagdure ◽

William Blackwelder ◽

Brady S Moffett ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Length Of Stay ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Hospital Length Of Stay ◽

P Value ◽

Diaphragm Dysfunction

AbstractBackground:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

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Single Institution Experience With International Referrals for Pediatric Cardiac Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120937230 ◽

2020 ◽

Vol 11 (6) ◽

pp. 727-732

Author(s):

Michael A. Rebolledo ◽

T. K. Susheel Kumar ◽

James B. Tansey ◽

Bill Pickens ◽

Jerry Allen ◽

...

Keyword(s):

Cardiac Surgery ◽

Congenital Heart ◽

Heart Surgery ◽

Operative Mortality ◽

Congenital Heart Surgery ◽

Pediatric Cardiac Surgery ◽

Patient Demographics ◽

Included Patient ◽

Surgical Complexity ◽

Surgery Mortality

Background: Pediatric cardiac surgery in developing countries poses many challenges. The practice of referring patients from abroad via nongovernmental organizations has occurred for many years. We describe our experience with international referrals for pediatric cardiac surgery via Gift of Life Mid-South to the Heart Institute, Le Bonheur Children’s Hospital in Memphis, Tennessee. Methods: We performed a retrospective descriptive review of data collected in our Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) along with data from our electronic medical record from January 1, 2007, to December 31, 2017. Available data included patient demographics, diagnoses, surgical procedure, entire inpatient length of stay (LOS), complications, and operative mortality. Cardiac surgeries were grouped according to the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT Mortality Categories). Complications were defined according to the STS CHSD. Results: In this retrospective descriptive study, case complexity level varied; however, 38% cardiac surgeries were in STAT Mortality Category 3 or 4. Honduras was the most common referral source with a total of 18 countries represented. Operative mortality remained very low (1 [1.4%] of 71 cardiac surgeries) despite patients being referred beyond infancy. There were an increasing number of complications and longer inpatient LOS (with greater variance) in STAT Mortality Category 4. Conclusions: International patients referred for congenital heart surgery can be successfully treated with an acceptable mortality rate despite late referrals. Inpatient LOS is related to surgical complexity. Follow-up studies are needed to determine the long-term outcomes of these patients.

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Abstract 12630: Association Between Z-score for Birth Weight and Postoperative Outcomes in Neonates and Infants With Congenital Heart Disease

Circulation ◽

10.1161/circ.142.suppl_3.12630 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Martina A Steurer ◽

Shabnam Peyvandi ◽

John M Costello ◽

Anita J Moon-Grady ◽

Robert Habib ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Birth Weight ◽

Gestational Age ◽

Congenital Heart ◽

Heart Surgery ◽

Operative Mortality ◽

Congenital Heart Surgery ◽

Growth Restriction ◽

Z Score

Background: Neonates with congenital heart disease are more likely to be small for gestational age. Few studies have investigated the effect of birth weight Z-score on outcomes after congenital heart surgery. Methods: Patients from the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2016) undergoing cardiac surgery at a corrected gestational age ≤ 44 weeks were included, and classified as severely (birth weight Z-score -4 to -2), moderately (Z-score between -2 and -1) and mildly growth restricted (Z-score -1.0 to -0.5) and compared to a reference (Z-score 0 to 0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality, postoperative complications and length of stay, adjusting for other patient characteristics. Interaction between Z-score for birth weight and gestational age was assessed. Results: In 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared to the reference group with no growth restriction, the adjusted odds (AOR) of mortality was increased in infants with severe (AOR 2.4, CI 2.0-3.0), moderate (AOR 1.7, CI 1.4-2.0) and mild growth restriction (AOR 1.4, CI 1.2-1.6). The AOR for major postoperative complications was increased for infants with severe (AOR 1.4, CI 1.2-1.7) and moderate growth restriction (AOR 1.2, CI 1.1-1.4), but not in mildly growth restricted infants (AOR 1.0, CI 0.9-1.2). Length of stay was prolonged for all growth restricted cohorts (adjusted Hazard Ratio<1, p<0.05 for all). There was significant interaction between birth weight Z-score and gestational age (p=0.007) with the strongest association between birth weight Z-score and operative mortality in early-term (gestational age 37-38 weeks), followed by full-term (>38 weeks) and then preterm infants (<37 weeks). Conclusions: Even birth weight Z-scores that are slightly below average are independent risk factors for mortality and morbidity in neonates undergoing cardiac surgery. The strongest association between poor fetal growth and operative mortality exists in early-term neonates. These novel findings may account for some of the previously unexplained variation in cardiac surgical outcomes.

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Nineteen Years of Adult Congenital Heart Surgery in a Single Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116682454 ◽

2017 ◽

Vol 8 (2) ◽

pp. 182-188

Author(s):

Madurra Perinpanayagam ◽

Signe H. Larsen ◽

Kristian Emmertsen ◽

Marianne B. Møller ◽

Vibeke E. Hjortdal

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Postoperative Complications ◽

Adverse Events ◽

Congenital Heart ◽

Postoperative Bleeding ◽

Registration System ◽

Growing Population

Background: Adults with congenital heart disease are a growing population. We describe surgical interventions, short- and long-term mortality and morbidity, and risk factors for adverse events in a population-based cohort. Methods: Patients over or equal to 18 years with congenital heart disease who underwent cardiac surgery at Aarhus University Hospital, Denmark, from 1994 to 2012 were included in the study. Diagnoses, surgical procedures, postoperative complications, and survival were identified in hospital databases, medical records, and the Danish Civil Registration System. Results: Four hundred seventy-four surgeries were performed in 445 adults (50% men). The median age was 39 years (range 18-83). Thirty-nine percent had previous surgical or catheter-based interventions. Thirty-day and in-hospital mortality were 1.1%. Postoperative complications occurred in 50% of cases, most were minor such as temporary arrhythmias and pneumonia. Major complications included postoperative bleeding necessitating intervention (6%), stroke (2%), and acute temporary renal failure (1%). Multivariate analysis identified RACHS-1 categories over or equal to 3 compared to category 1 (odds ratio (OR) = 2.3; 95% confidence interval (CI): 1.5-3.7), New York Heart Association functional class III and IV compared to class I (OR = 2.2; 95% CI: 1.3-3.7) and age at surgery (OR = 1.03, 95% CI: 1.01-1.04), as risk factors for adverse events. Survival during a median follow-up of 7.8 years (range 0 days-21.4 years) was 85% (95% CI: 80%-89%). Conclusion: Adults with congenital heart disease constitute a growing population with the need for cardiac surgery. Postoperative complications are frequent but early and late mortality are low.

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