Main Risk Factors for Mortality After Cardiovascular Interventions in Newborns with Critical Congenital Heart Diseases

Abstract

Objective: It was aimed to define the main risk factors that affect mortality in infants with critical congenital heart disease (CHD). Material and Methods: We analyzed data from 105 infants with critical CHD underwent cardiovascular intervention at a tertiary neonatal intensive care unit (NICU) between September 2010 and January 2012. Demographic data, clinical findings (before and after intervention), type of intervention, and intervention risk score according to Risk Adjustment in Congenital Heart Surgery (RACHS-1) classification were evaluated. Results: The mean age at cardiovascular intervention was 15.2±11.8 days. Transcatheter interventions were performed in 29 patients (27.6%). Seventy-six patients (72.4%) underwent cardiovascular surgery. At post-interventional period, the rates of low cardiac output, pneumonia, and sepsis were significantly higher among patients underwent surgical intervention. Length of NICU stay was also longer among them. Overall mortality rate was 35.2% (n=37). Mortality was significantly lower in infants underwent transcatheter intervention. Univariate analyses showed that nonsurvivors differed from survivors in terms of gestational age, prematurity, the presence of associated disorder, pre-interventional need of mechanical ventilation, need of inotropic support, the presence of pulmonary hypertension and sepsis, requirement of cardiovascular surgery, age at intervention, and RACHS-1 score. Multivariate analysis showed that higher RACHS-1 score was associated with mortality (OR: 4.5, 95% CI (1.5-13.1), p=0.005) while higher gestational age was a preventive factor (OR: 0.6, 95% CI (0.5-0.9), p=0.01). Conclusion: Our study indicates that lower gestational age and severity of the disease seem to be most possible risk factors for mortality among infants with critical CHD.

Evaluation of critical congenital heart disease from 2018 to 2020 in Turkey: a retrospective cohort study

“…Similarly, the disease with the highest mortality in our study was HLHS with a mortality rate of 81.9%. In our study, prematurity, SGA at birth, multiple pregnancy, maternal age at birth, CCHD group are the variables associated with survival in line with the literature [11,26,27,51]. In a study conducted in Brazil, prematurity, LBW, multiple pregnancy, comorbidity/congenital anomaly were associated with increased mortality in CCHD [11].…”

“…In recent years, although CCHD mortality has decreased gradually, the mortality of this group of diseases is still high [8,11,19,26,27,47]. Our study showed that while the mortality rate in the birth cohort was 16.6% in the neonatal period, it reached 31.6% and 33.7% at the end of the first and second years, respectively.…”

“…Recently, the issue of CCHD and its screening is on the agenda in Turkey, and many hospital-based studies have been conducted [25][26][27][28][29][30][31][32][33][34][35]. In addition, newborn pulse oximetry screening for CCHD has been recommended by the Ministry of Health (MoH), but newborn screening test is not mandatory as in many countries [23,36,37].…”

Investigation of infant deaths associated with critical congenital heart diseases; 2018–2021, Türkiye

“…The mortality and survival of CCHD varies in various countries and regions around the world [ 8 , 10 , 14 – 17 , 19 , 20 , 30 ]. In a study conducted in Brazil between 2014 and 2016 evaluating survival and risk factors for death in newborns with critical and/or complex congenital heart disease in the neonatal period, the death rate was found to be 8.1 per 10,000 live births [ 14 ].…”

“…58% of them died before surgery and 81% of preoperative deaths were during palliative care [ 30 ]. In a study in which 105 patients with CCHD who were followed up in a tertiary neonatal intensive care unit in Türkiye between 2010 and 2012, the mortality rate was 35.2% while in another tertiary center in 2017–2018, evaluating perioperative mortality in cases requiring intervention in the neonatal period, the overall mortality and the intervention mortality were found 27% and 22% respectively [ 19 , 20 ]. Several factors linked to CCHD mortality have been documented in prior studies.…”