scholarly journals Outcome of adult congenital heart disease patients undergoing cardiac surgery: clinical experience of dr. Sardjito hospital

2019 ◽  
Vol 13 (S11) ◽  
Author(s):  
Juni Kurniawaty ◽  
Yunita Widyastuti
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Length Of Stay ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Laboratory Test Results ◽  
Adult Congenital

Abstract Background Patients with congenital heart disease require surgery to correct the cardiac defect they had in order to prevent heart failure. Unfortunately, data regarding outcome of adult CHD in Indonesia is still limited. In contrast with developed countries, many congenital heart surgery patients in developing countries are adults. The purpose of this study was to investigate the outcomes of cardiac surgery procedures among adult congenital heart disease patients, and what factors that might influence the outcome of surgery. Methods A retrospective study was performed on adult congenital heart disease patients undergoing cardiac surgery at Dr. Sardjito Hospital between April 2018 and March 2019. Variables included in the study were demographic characteristics, laboratory test results, comorbidities, premedication, Cardiopulmonary Bypass (CPB) and ischemia duration were included in the analysis. Outcomes were in-hospital mortality, hospital length of stay, and ICU length of stay. Results A total of 25 congenital heart disease patients [19 Atrial Septeal Defect (ASD) patients, and 6 Ventricular Septal Defect (VSD) patients] underwent a cardiac surgery procedure at Dr. Sardjito Hospital during the study period. Mean age was 31 ± 14.92 years. The majority of patients had pulmonary hypertension. During the study period, none of the patients died during postoperative care in the hospital, mean hospital length of stay (LOS) was 8.35 ± 3.39 days and ICU LOS was 26.53 ± 11.33 h. Conclusion Surgery in adult patients with congenital heart disease may be successfully performed with low morbidity and mortality.

scholarly journals Early extubation following cardiac surgery in adult congenital heart disease improves post-operative haemodynamics and reduces costs

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Costola ◽  
A Constantine ◽  
P Bianchi ◽  
S Mele ◽  
D Shore ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Functional Class ◽  
Hospital Length Of Stay ◽  
Early Extubation ◽  
High Dependency ◽  
Adult Congenital

Abstract Background In paediatric cardiac surgery, there has been a paradigm shift in perioperative management from a slow wean of mechanical ventilation in the intensive care unit (ICU), to “ultra fast-track” anaesthesia with early extubation (EE) in theatre to promote a faster recovery. Adults with congenital heart disease (ACHD) have multiple risk factors for prolonged intubation, including a greater proportion of re-do interventions, more co-morbidities and metabolic differences leading to slower emergence from anaesthesia. As a result, EE remains unproven and has not been widely adopted and in this patient group. Aim To assess the effects of EE on post-operative haemodynamics, hospital stay and associated healthcare costs. Methods Data were collected on ACHD patients, who underwent cardiac surgery in a high-volume tertiary centre between 2012 and 2018. Propensity score matching (1:1 or 2:1 where possible) was performed using the following variables: age, sex, body mass index, CHD complexity, functional class, length of surgery, systemic ventricular function, procedure-specific risk (adult congenital heart score; ACHS), urgent versus elective procedure, active endocarditis, pulmonary hypertension and renal dysfunction. Results 614 procedures were performed during the study period. After matching, 87 (14.2%) patients receiving EE were compared to 164 patients who received conventional care (CC). The overall complication rate was low, with no difference between the EE and CC groups (8.0% vs. 9.1%, p=0.77), and a very low reintubation rate (<1%). EE patients had a significantly shorter post-operative hospital length of stay in ICU and the high dependency unit (HDU; 48 [43–51] vs. 50 [47–69] hours, p<0.0001). EE patients required less inotropic & vasopressor support, as demonstrated by a lower Vasoactive-Inotropic Score (VIS) compared to patients following NEE (median VIS 0.5 [0.0–1.8] vs. 2.0 [0.0–3.5], p<0.0001). The total fluid balance by the third post-operative day was more positive after CC than EE (1177±737mL vs. 927±780mL, p=0.004). Finally, lower combined ICU and HDU costs were incurred by EE compared with CC (£3.9K[2.8–4.2K] vs. £4.2K[3.9–6.3K], p<0.0001). Conclusion In ACHD patients undergoing cardiac surgery, including complex and redo procedures, EE was safe, associated with a shorter ITU and HDU stay and lower hospital costs. Funding Acknowledgement Type of funding source: None

Morbidity After Cardiac Surgery in Patients With Adult Congenital Heart Disease in Comparison With Acquired Disease

2018 ◽  
Vol 27 (6) ◽  
pp. 739-744 ◽  
Author(s):  
Dimos Karangelis ◽  
Amine Mazine ◽  
Sreekanth Narsupalli ◽  
Shamarli Mendis ◽  
Gruschen Veldtman ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Adult Congenital

scholarly journals Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease

2016 ◽  
Vol 152 (5) ◽  
pp. 1423-1429.e1 ◽  
Author(s):  
Bradley Scherer ◽  
Elizabeth A.S. Moser ◽  
John W. Brown ◽  
Mark D. Rodefeld ◽  
Mark W. Turrentine ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Length Of Stay ◽  
Congenital Heart ◽  
Hospital Length ◽  
Hospital Length Of Stay

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

2019 ◽  
Vol 30 (1) ◽  
pp. 62-65 ◽  
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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