Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

Background: Postsurgical sepsis is one of the main causes of the high mortality and morbidity after open congenital heart surgery in infants. This study aimed to evaluate the role of cardiopulmonary bypass duration, thymectomy, surgical complexity, and nutritional status on postsurgical sepsis after open congenital cardiac surgery in infants.Methods: A total of 40 patients <1 year of age with congenital heart disease, Aristotle Basic Score (ABS) ≥6 were followed for clinical and laboratory data before and after surgery until the occurrence of signs or symptoms of sepsis or until a maximum of 7 days after surgery. Bivariate analyses were performed. Variables with p≤0.200 were then included for logistic regression.Results: Duration of cardiopulmonary bypass ≥90 minutes was associated with 5.538 increased risk of postsurgical sepsis in comparison to those ≤90 minutes (80% vs 25%, RR=5.538, p=0.006). No association was observed between the incidence of postsurgical sepsis with poor nutritional status (86% vs 84%, RR=1.059, p=1.000), thymectomy (and 50% vs 76%, RR=0.481, p=0.157), and Aristotle Basic Score (p=0.870).Conclusion: Cardiopulmonary bypass time influences the incidence of sepsis infants undergoing open congenital cardiac surgery. Further studies are needed to elaborate a number of risk factors associated with the incidence of sepsis in this population.

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Abstract 14857: Outcomes of Bloodless Congenital Cardiac Surgery on Cardiopulmonary Bypass

Circulation ◽

10.1161/circ.142.suppl_3.14857 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

anas abdul kayoum ◽

Estefania Rivera ◽

Marcelle Reyes ◽

Saleem Almasarweh ◽

Jorge ojito ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Blood Transfusion ◽

Hospital Stay ◽

Congenital Heart ◽

Heart Surgery ◽

Blood Product Transfusion ◽

Congenital Cardiac Surgery

Introduction: Bloodless cardiac surgery defined as blood transfusion-free open-heart surgery, where cardiopulmonary bypass (CPB) circuits primed with crystalloid only and no intraoperative blood transfusion. Limited data have been published in this field. Hypothesis: We asked whether blood conservative surgery is feasible in congenital heart disease. Methods: We retrospectively reviewed patients who underwent bloodless cardiac surgery for congenital heart disease on CPB between January 2016 and December 2018. Our unique CPB system utilizes assisted venous drainage, bioactive coating, and reduced tubing size to decrease priming volume, and complement activation. Results: A total of 164 patients were reviewed (86 male and 78 female) at a median age of 9.6 years (range, 13 months-55 years), weight of 32 kg (IQR, 16-55), preoperative hemoglobin 13.7 g/dl (IQR, 12.6-14.9), and preoperative hematocrit of 40.3% (IQR, 37.2-44.3). Median CPB time was 81.5 minutes (IQR, 58-125), and median hematocrit coming off CPB was 26% (IQR, 23-29.7). Congenital Heart Surgery risk (STAT) category distributed in STAT 1 for 70 (43%), STAT 2 for 80 (49%), STAT 3 for 9 (5%), and STAT 4 for 5 (3%) of the patients. The majority (95%) of patients were extubated in the operating room with low complications rate during the hospital stay (7%). Only 6 (4%) patients needed a blood transfusion in the postoperative period with higher incidence of complications during the hospital course (LR 14.9; p<0.001). The median length of hospital stay was 3.6 days (IQR 2.6-5.6). There was no in-hospital mortality or 30 days mortality after surgery. Conclusions: Bloodless congenital cardiac surgery has a high success rate in selected low to medium surgical risk and even higher risk patients (STAT 3 and 4). Our patients had a low rate of complications and short hospital course. The blood product transfusion correlated significantly with a higher rate of complications during the postoperative course.

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

Cardiology in the Young ◽

10.1017/s1047951109990151 ◽

2009 ◽

Vol 19 (4) ◽

pp. 360-369 ◽

Cited By ~ 12

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.

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A National Survey: Current Clinical Practice in Pediatric Anesthesia for Congenital Heart Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120902122 ◽

2020 ◽

Vol 11 (3) ◽

pp. 257-264

Author(s):

Torsten Baehner ◽

Nicholas Kiefer ◽

Shahab Ghamari ◽

Ingo Graeff ◽

Christopher Huett ◽

...

Keyword(s):

Cardiac Surgery ◽

Congenital Heart ◽

Heart Surgery ◽

Anesthetic Management ◽

Pediatric Anesthesia ◽

Congenital Heart Surgery ◽

Online Questionnaire ◽

Volatile Agent ◽

Congenital Cardiac Surgery ◽

First Choice

Background: Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany. Methods: All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program. Centers with an active program for congenital cardiac surgery were interviewed to participate in the present online questionnaire to assess their current anesthetic practice. Results: Twenty-seven German centers running an active program for congenital heart surgery were identified, covering more than 3,000 pediatric cardiac surgeries annually. Of these centers, 96.3% (26/27) participated in our survey. Standard induction agents were etomidate in 26.9% (7/26), propofol in 19.2% (5/26), a combination of benzodiazepines and ketamine in 19.2% (5/26), and barbiturates in 11.5% (3/26). General anesthesia was preferentially maintained using volatile agents, 61.5% (16/26), with sevoflurane being the most common volatile agent within this group, 81.2% (13/16). Intraoperative first-choice/first-line inotropic drug was epinephrine, 53.8% (14/26), followed by milrinone, 23.1% (6/26), and dobutamine 15.4% (4/26). Fast-track programs performing on-table extubation depending on the type of surgical procedure were established at 61.5% (16/26) of the centers. Conclusion: This study highlights the diversity of clinical standards in pediatric cardiac anesthesia for congenital cardiac surgery in Germany.

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The diagnostic value of combined indexes in Acute Renal injury after Cardiopulmonary Bypass Surgery in infants with Congenital Heart Disease

10.21203/rs.3.rs-15732/v1 ◽

2020 ◽

Author(s):

Haifei Yu ◽

Xinrui Wang ◽

Qiang Chen ◽

Liangpu Xu ◽

Hua Cao

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Congenital Heart ◽

Hepatic Function ◽

Blood Oxygen ◽

Acute Renal Injury ◽

Blood Oxygen Saturation

Abstract Objective: To investigate the incidence and risk factors of acute renal injury (AKI) after cardiopulmonary bypass (CPB) cardiac surgery in infants with congenital heart disease(CHD). Methods: Single-center data from a total of 613 infants with congenital heart disease who underwent cardiothoracic surgery in Fujian Union Hospital.The included patients were divided into two groups according to the occurrence of AKI: AKI group (n = 68) and non-AKI group (n = 92). We obtained clinical data from the electronic hospitalization information system and the laboratory database. All infants were tested for serum creatinine at least twice within 12 hours of admission and after operation. We determined AKI events according to creatinine criteria for improving global prognosis of renal diseases.The general and clinical data of the infants were collected, and the related risk factors were explored by univariate analysis and Logistic regression analysis. Results: 160 patients had congruent lab and echocardiogram data foranalysis. Most of patients are male (56.26%). Original congenital cardiac malformation is similar with our study, the most common is left-to-right shunt CHD(58%), followed by right-to-left shunt CHD(18.75%). All patients showed differences in liver function, renal function, cardiac function and inflammatory indexes within 12 hours of admission and after operation(p<0.05). The AKI group and non-AKI group showed Significant statistical difference in arein age, serum myocardial enzyme , hepatic function, ejection fraction , hemoglobin , platelet count were significantly different meaning (p<0.05). Regression analyses showed that blood oxygen saturation (95%CI 1.003-2.999), CREA(95%CI 1.070-1.253), UREA(95%CI 1.180-3.325), CRP(95%CI 1.006-1.058), BNP(95%CI 0.999-1.000) at 12 hours postoperatively, and in admission to PCT (95%CI 0.461-0.936), Neu(95%CI 0.909-0.995), ALP(95%CI 1.070-1.253) , nadir intraoperative renal regional tissue oximetry to be independent predictors of postoperative kidney damage as measured by blood oxygen saturation, hepatic function, kidney function, cardiac function , Serum myocardial enzyme , inflammatory factor s and blood Routine . Conclusions: Choosing the best age for infants's cardiac surgery, actively preventing preoperative complica- tions, postoperative pneumonia, heart failure and hypoxia play an important role in preventing AKI.

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A retrospective study of perioperative clinical seizures and epilepsy in children after operation for CHD

Cardiology in the Young ◽

10.1017/s1047951121005011 ◽

2021 ◽

pp. 1-7

Author(s):

Takeshi Ikegawa ◽

Shin Ono ◽

Kouji Yamamoto ◽

Mikihiro Shimizu ◽

Sadamitsu Yanagi ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

White Matter ◽

Risk Adjustment ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

White Matter Integrity ◽

Partial Regression Coefficient ◽

Clinical Seizure

Abstract This study investigated the incidence and risk factors of perioperative clinical seizure and epilepsy in children after operation for CHD. We included 777 consecutive children who underwent operation from January 2013 to December 2016 at Kanagawa Children’s Medical Center, Kanagawa, Japan. Perinatal, perioperative, and follow-up medical data were collected. Elastic net regression and mediation analysis were performed to investigate risk factors of perioperative clinical seizure and epilepsy. Anatomic CHD classification was performed based on the preoperative echocardiograms; cardiac surgery was evaluated using Risk Adjustment in Congenital Heart Surgery 1. Twenty-three (3.0%) and 15 (1.9%) patients experienced perioperative clinical seizure and epilepsy, respectively. Partial regression coefficient with epilepsy as the objective variable for anatomical CHD classification, Risk Adjustment in Congenital Heart Surgery 1, and the number of surgeries was 0.367, 0.014, and 0.142, respectively. The proportion of indirect effects on epilepsy via perioperative clinical seizure was 22.0, 21.0, and 33.0%, respectively. The 15 patients with epilepsy included eight cases with cerebral infarction, two cases with cerebral haemorrhage, and three cases with hypoxic-ischaemic encephalopathy; white matter integrity was not found. Anatomical complexity of CHD, high-risk cardiac surgery, and multiple cardiac surgeries were identified as potential risk factors for developing epilepsy, with a low rate of indirect involvement via perioperative clinical seizure and a high rate of direct involvement independently of perioperative clinical seizure. Unlike white matter integrity, stroke and hypoxic-ischaemic encephalopathy were identified as potential factors for developing epilepsy.

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Verification of data in congenital cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951108002862 ◽

2008 ◽

Vol 18 (S2) ◽

pp. 177-187 ◽

Cited By ~ 85

Author(s):

David R. Clarke ◽

Linda S. Breen ◽

Marshall L. Jacobs ◽

Rodney C.G. Franklin ◽

Zdzislaw Tobota ◽

...

Keyword(s):

Cardiac Surgery ◽

United Kingdom ◽

Thoracic Surgery ◽

European Association ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Congenital Cardiac Surgery ◽

The United Kingdom

AbstractAccurate, complete data is now the expectation of patients, families, payers, government, and even media. It has become an obligation of those practising congenital cardiac surgery. Appropriately, major professional organizations worldwide are assuming responsibility for the data quality in their respective registry databases.The purpose of this article is to review the current strategies used for verification of the data in the congenital databases of The Society of Thoracic Surgeons, The European Association for Cardio-Thoracic Surgery, and The United Kingdom Central Cardiac Audit Database. Because the results of the initial efforts to verify data in the congenital databases of the United Kingdom and Europe have been previously published, this article provides a more detailed look at the current efforts in North America, which prior to this article have not been published. The discussion and presentation of the strategy for the verification of data in the congenital heart surgery database of The Society of Thoracic Surgeons is then followed by a review of the strategies utilized in the United Kingdom and Europe. The ultimate goal of sharing the information in this article is to provide information to the participants in the databases that track the outcomes of patients with congenitally malformed hearts. This information should help to improve the quality of the data in all of our databases, and therefore increase the utility of these databases to function as a tool to optimise the management strategies provided to our patients.The need for accurate, complete and high quality Congenital Heart Surgery outcome data has never been more pressing. The public interest in medical outcomes is at an all time high and “pay for performance” is looming on the horizon. Information found in administrative databases is not risk or complexity adjusted, notoriously inaccurate, and far too imprecise to evaluate performance adequately in congenital cardiac surgery. The Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery databases contain the elements needed for assessment of quality of care provided that a mechanism exists within these organizations to guarantee the completeness and accuracy of the data. The Central Cardiac Audit Database in the United Kingdom has an advantage in this endeavour with the ability to track and verify mortality independently, through their National Health Service.A combination of site visits with “Source Data Verification”, in other words, verification of the data at the primary source of the data, and external verification of the data from independent databases or registries, such as governmental death registries, may ultimately be required to allow for optimal verification of data. Further research in the area of verification of data is also necessary. Data must be verified for both completeness and accuracy.

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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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Initial experience with del Nido cardioplegia solution at a Pediatric and Congenital Cardiac Surgery Program in Brazil

Perfusion ◽

10.1177/02676591211020471 ◽

2021 ◽

pp. 026765912110204

Author(s):

Luiz Fernando Caneo ◽

Gregory S Matte ◽

Aida Luiza R Turquetto ◽

Luana Marques de Carvalho Pegollo ◽

Maria Clara Amato Miglioli ◽

...

Keyword(s):

Cardiac Surgery ◽

Outcome Measures ◽

Myocardial Protection ◽

Congenital Heart ◽

Heart Surgery ◽

Ventricular Dysfunction ◽

Congenital Heart Surgery ◽

Cardioplegia Solution ◽

Congenital Cardiac Surgery ◽

Reperfusion Period

Objective: The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients. Methods: Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas’ solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality. Results: Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance. Conclusion: In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas’ solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.

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

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117704657 ◽

2017 ◽

Vol 8 (4) ◽

pp. 435-439 ◽

Cited By ~ 1

Author(s):

Carlos A. Villa-Hincapie ◽

Marisol Carreno-Jaimes ◽

Carlos E. Obando-Lopez ◽

Jaime Camacho-Mackenzie ◽

Juan P. Umaña-Mallarino ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Heart Surgery ◽

Operative Mortality ◽

Congenital Heart Surgery ◽

Pediatric Cardiac Surgery ◽

Cross Clamp Time

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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Programmatic Changes to Reduce Mortality and Morbidity in Humanitarian Congenital Cardiac Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117737686 ◽

2018 ◽

Vol 9 (1) ◽

pp. 47-53 ◽

Cited By ~ 6

Author(s):

Tyler J. Wallen ◽

George J. Arnaoutakis ◽

Randa Blenden ◽

Rodrigo Soto

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Ductus Arteriosus ◽

Reoperation Rate ◽

Congenital Heart Surgery ◽

Mortality And Morbidity ◽

Congenital Cardiac Surgery ◽

Septal Defects ◽

Surgical Mission ◽

Reduction Of Mortality

Background: This report documents the outcomes of cardiac surgical mission trips organized by the International Children's Heart Foundation (ICHF), a nongovernmental organization that provides congenital heart surgery services to the developing world, and discusses factors associated with a reduction of mortality and morbidity in this setting. Methods: A retrospective review of a prospectively maintained database was conducted to identify any patient who underwent surgical intervention during the course of an ICHF mission trip. Results: From 2008 to 2016, a total of 223 trips were made to 23 countries and 3,783 operations were performed. Over 40 unique types of operations were performed with repairs of atrial septal defects (ASDs; n = 479), ventricular septal defects (VSDs; n = 760), teratology of Fallot (n = 473), and ligation of patient ductus arteriosus (PDA; n = 242), comprising the majority of cases. Several organizational policy changes were instituted in 2015. These include the requirement of the host site to have a fully functional blood bank and access to medical subspecialties, the ICHF providing 24-hour intensivist coverage, and not performing surgery on patients weighing less than 10 kg until local capacity has been developed. The overall mortality rate fell to 2.3% from 8.1% after the implementation of these policies. The mortality for ASD repair, VSD repair, PDA ligation, and the repair of tetralogy of Fallot fell from 1.2% to 0%, 1.8% to 0%, 0% to 0%, and 5.6% to 5.1%, respectively. The reoperation rate fell from 11% to 3% and reoperation for a bleeding indication fell from 6% to 2%. Conclusions: Programmatic-level changes have been associated with reduced rates of mortality and morbidity in humanitarian congenital cardiac surgery.

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