Preoperative Determinants of Outcomes of Infant Heart Surgery in a Limited-Resource Setting

Reddy, N. Srinath; Kappanayil, Mahesh; Balachandran, Rakhi; Jenkins, Kathy J.; Sudhakar, Abish; Sunil, Gopalraj Sumangala; Raj, Renjima; Kumar, Raman Krishna

doi:10.1053/j.semtcvs.2015.09.008

Cited by 32 publications

(43 citation statements)

References 28 publications

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“…91,92 In children with congenital heart disease that is amenable to a highly technical but relatively effective surgical procedure (eg, ventricular septal defect), creating centres especially designed to serve these patients might be a viable approach to treatment. 93 Similarly, we know that high-volume kidney transplant centres can achieve good outcomes. 94,95 …”

Section: Pathways To Addressing Cvrds In Lmicsmentioning

confidence: 99%

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

et al. 2018

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Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

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Section: Pathways To Addressing Cvrds In Lmicsmentioning

confidence: 99%

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

et al. 2018

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“…14 The co-existence of CHD increases the likelihood and severity of undernutrition, and this adds to challenges for the management of CHD including resource constraints; late presentation and diagnosis; and perioperative infection. [15][16][17][18] The number of children, including infants and newborns being operated for CHD, has recently increased in these regions. 15 This review seeks to summarise existing evidence on prevalence of undernutrition and CHD and its impact on surgical outcomes with a focus on implications for low-and middle-income countries.…”

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confidence: 99%

Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries

et al. 2017

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Poor growth with underweight for age, decreased length/height for age, and underweight-for-height are all relatively common in children with CHD. The underlying causes of this failure to thrive may be multifactorial, including innate growth potential, severity of cardiac disease, increased energy requirements, decreased nutritional intake, malabsorption, and poor utilisation of absorbed nutrition. These factors are particularly common and severe in low-and middle-income countries.Although nutrition should be carefully assessed in all patients, failure of growth is not a contraindication to surgical repair, and patients should receive surgical repair where indicated as soon as possible.Close attention should be paid to nutritional support -primarily enteral feeding, with particular use of breast milk in infancy -in the perioperative period and in the paediatric ICU. This nutritional support requires specific attention and allocation of resources, including appropriately skilled personnel.Thereafter, it is essential to monitor growth and development and to identify causes for failure to catch-up or grow appropriately.

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“…Similar to the abovementioned studies, a significant relationship was found between sepsis and prolonged postoperative ventilation. The incidence of sepsis was demonstrated to be higher particularly in pediatric cardiac surgery patients with a prolonged length of preoperative hospital stay, in patients who required pre-operative mechanical ventilation, and preoperative hospitalisation in intensive care [20] . Such patients were colonized with resistant organisms of the ICU, so they were inappropriately prepared for surgery and their already weakened immune systems became more prone to infection through the effect of so many factors.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Sepsis Following Congenital Heart Surgery

Yavuz¹,

Yurtseven²,

Aydemir³

et al. 2019

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Objective: This study aims to evaluate the incidence and risk factors associated with sepsis in pediatric patients who underwent congenital heart surgery. Method: A total of 289 patients were prospectively enrolled in this study. Patients were divided into two groups according to the Society of Critical Care Medicine (SSCM) diagnostic criteria as Group I including 28 patients who fulfilled the criteria for sepsis and Group II including 261 patients without diagnosis of sepsis. Demographic information, type of operation, complexity, duration of preoperative hospitalization (>5 days) and intensive care unit (ICU) stay, requirement for mechanical ventilation (MV), history of pulmonary hypertension (PHT), and requirement for emergency surgery, total cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times. During the postoperative period delayed sternal closure, duration of mechanical ventilation, the need for reintubation, and need for reoperation were also recorded. Results: The incidence of sepsis was 4.74%. The mortality rate in septic patients was 32%. Factors associated with sepsis were younger age, low body weight, duration of preoperative hospitalization and ICU stay, preoperative requirement for MV, palliative and emergency interventions, history of PHT, prolonged MV, reintubation, and reoperation. Multivariate analysis identified reintubation and duration of MV as the major risk factors for sepsis. Conclusion: Serious infectious problems, such as sepsis, are encountered due to inadequate development of immune resistance mechanisms in pediatric patients. Appropriate preoperative preparation of patients for surgery, reducing the length of stay in the hospital and in the ICU, and reducing the need for reintubation by extubating the patients for an optimal period, would reduce the mortality rate due to sepsis.

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Preoperative Determinants of Outcomes of Infant Heart Surgery in a Limited-Resource Setting

Cited by 32 publications

References 28 publications

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries

Risk Factors for Sepsis Following Congenital Heart Surgery

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