Invited Commentary: Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality: STAT 2020

Objectives: The Japan Cardiovascular Surgery Database–Congenital section (JCVSD-Congenital) and the European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) share the same nomenclature. We aimed at comparing congenital cardiac surgical patterns of practice and outcomes in Japan and Europe using the JCVSD-Congenital and ECHSA-CHSD. Methods and Results: We examined Japanese (120 units, 63,365 operations) and European (96 units, 90,098 operations) data in JCVSD-Congenital and ECHSA-CHSD from 2011 to 2017. Patients’ age and weight, periprocedural times, mortality at hospital discharge, and postoperative length of stay were calculated for ten benchmark operations. There was a significantly higher proportion of ventricular septal defect closures and Glenn operations and a significantly lower proportion of coarctation repairs, tetralogy of Fallot repairs, atrioventricular septal defect repairs, arterial switch operations, truncus repairs, Norwood operations, and Fontan operations in JCVSD-Congenital compared to ECHSA-CHSD. Postoperative length of stay was significantly longer following all benchmark operations in JCVSD-Congenital compared to ECHSA-CHSD. Mean STAT mortality score (Society of Thoracic Surgeons European Association for Cardio-Thoracic Surgery mortality score) was significantly higher in JCVSD-Congenital (0.78) compared to ECHSA-CHSD (0.71). Mortality at hospital discharge was significantly lower in JCVSD-Congenital (4.2%) compared to ECHSA-CHSD (6.0%, P < .001). Conclusions: The distribution of the benchmark procedures and age at the time of surgery differ between Japan and Europe. Postoperative length of stay is longer, and the mean complexity is higher in Japan compared to European data. These comparisons of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.

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Status of cardiovascular surgery in Japan: a report based on the Japan Cardiovascular Surgery Database 2017–2018. 1. Congenital heart surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320981501 ◽

2020 ◽

pp. 021849232098150

Author(s):

Yasutaka Hirata ◽

Norimichi Hirahara ◽

Arata Murakami ◽

Noboru Motomura ◽

Hiroaki Miyata ◽

...

Keyword(s):

European Association ◽

Congenital Heart ◽

Heart Surgery ◽

Cardiovascular Surgery ◽

Mortality Rates ◽

Congenital Heart Surgery ◽

Mortality And Morbidity ◽

Defect Repair ◽

Surgery Mortality ◽

Anomalous Pulmonary Venous Connection

Objectives We aimed to analyze the mortality and morbidity associated with congenital heart surgery in Japan. Methods Data on congenital heart surgeries performed between January 2017 and December 2018 were obtained from Japan Cardiovascular Surgery Database. The 20 most frequent procedures were selected, and mortalities and major morbidities associated with the procedures were analyzed. All procedures were classified into Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery mortality categories, and mortalities in each category were also analyzed. Results The mortality rates in atrial septal defect repair and ventricular septal repair were 0% and 0.2%, respectively. The mortality rates in more complex cases (tetralogy of Fallot repair, complete atrioventricular repair, bidirectional Glenn, and total cavopulmonary connection) were 2%–3%. The mortality rates in systemic-to-pulmonary shunt, total anomalous pulmonary venous connection repair, and the Norwood procedure were 4.9%, 11.1%, and 15.7%, respectively, which were not different from those reported in 2015–2016. The mortalities according to the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery categories 1–5 were 0.3%, 2.7%, 2.9%, 5.9%, and 15.5%, respectively, and comparable to those of the Society of Thoracic Surgeons database (2013–2016). Conclusion The mortality rates and frequency of complications in major surgical procedures for congenital heart disease in Japan in 2017–2018 will play an important role as a basis for trends in Japan and for comparison with results from other countries.

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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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