Quantification of Morbidity Associated with Congenital Heart Surgery

Sinzobahamvya, Nicodème; Weber, Toni; Sata, Sojiro; Haun, Christoph; Arenz, Claudia; Photiadis, Joachim; Schindler, Ehrenfried; Hraška, Viktor; Asfour, Boulos

doi:10.1055/s-0032-1328922

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…In line with our results, risk factors reflecting the extent of postoperative morbidities like the duration of mechanical ventilation, the need for parenteral nutrition, hospitalization time, and ICU stay have been described by other groups [37]. Moreover, the development of postoperative infections can also be involved in the formation of cardiac hepatopathy.…”

Section: Plos Onesupporting

confidence: 89%

Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease

et al. 2021

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Patients undergoing complex pediatric cardiac surgery in early infancy are at risk of postoperative secondary end-organ dysfunction. The aim of this study was to determine specific risk factors promoting the development of peri- and postoperative hepatopathy after surgery for congenital heart disease. In this retrospective study, we identified 20 consecutive patients operated between 2011 and 2019 from our institutional cohort who developed significant postsurgical hepatic dysfunction. These patients were compared to a control group of 30 patients with comparable initial cardiac conditions and STS-EACTS risk score. Patients who developed hepatopathy in the intensive care unit have chronic cholestasis and decreased liver synthesis. The impact of postoperative hepatopathy on morbidity was marked. In six patients (30%), liver transplantation was executed as ultima ratio, and two (10%) were listed for liver transplantation. The overall mortality related to postoperative hepatopathy is high: We found nine patients (45%) having severe hepatopathy and mostly multiple organ dysfunction who died in the postoperative course. According to risk analysis, postoperative right and left heart dysfunction in combination with a postoperative anatomical residuum needing a re-operation or re-intervention in the postoperative period is associated with a high risk for the development of cardiac hepatopathy. Furthermore, postoperative complications (pleural effusion, heart rhythm disorders, etc.), postoperative infections, and the need for parenteral nutrition also raise the risk for cardiac hepatopathy. Further investigations are needed to reduce hepatic complications and improve the general prognosis of such complex patients.

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Section: Plos Onesupporting

confidence: 89%

Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease

et al. 2021

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“…Perioperative outcomes (length of ICU stay, duration of mechanical ventilation, length of total hospital stay, complication rate) seemed comparable to routinely treated, non-charity funded patients in high-income countries. 19,21,23–28 Our host families play a major role in timely hospital discharge of our KHR patients, as they are very vigilant and experienced, thus enabling excellent care for several weeks after the procedure(s) and swift presentation at our center should any problems arise.…”

Section: Discussionmentioning

confidence: 99%

“…funded patients in high-income countries. 19,21,[23][24][25][26][27][28] Our host families play a major role in timely hospital discharge of our KHR patients, as they are very vigilant and experienced, thus enabling excellent care for several weeks after the procedure(s) and swift presentation at our center should any problems arise.…”

Section: Perioperative Outcome and Complicationsmentioning

confidence: 99%

Benefit From a Humanitarian Pediatric Congenital Heart Surgery Program Over a 10-Year Period

Fürniss

Leutwyler

Zürn

et al. 2023

World J Pediatr Congenit Heart Surg

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Background: The charity organization Kinderherzen retten e.V. (KHR) enables humanitarian congenital heart surgery for pediatric patients from low- and middle-income countries at the University Heart Center Freiburg, Germany. The aim of this study was to assess periprocedural and mid-term outcomes of these patients for evaluation of KHR sustainability. Methods: Part one of the study comprised retrospective medical chart analyses of the periprocedural course of all KHR-treated children from 2008 to 2017, and part two a prospective evaluation of their mid-term outcome, assessed by questionnaires concerning survival, medical history, mental and physical development, and socioeconomic situation. Results: Of the 100 consecutively presented children from 20 countries (median age 3.25 years), 3 patients were not invasively treatable, 89 underwent cardiovascular surgery, and 8 received a catheter intervention only. There were no periprocedural deaths. Median postoperative duration of mechanical ventilation, intensive care stay, and total hospital stay was 7 (interquartile range [IQR] 4-21) hours, 2 (IQR 1-3) days, and 12 (IQR 10-16) days, respectively. Mid-term postoperative follow-up demonstrated a 5-year survival probability of 94.4%. The majority of patients received continued medical care in their home country (86.2% of patients), were in good mental and physical condition (96.5% and 94.7% of patients, respectively), and able to engage in age-appropriate education/employment (98.3% of patients). Conclusions: Cardiac, neurodevelopmental, and socioeconomic outcomes of patients treated via KHR was satisfactory. Thorough pre-visit evaluation and close contact with local physicians are crucial when providing this high-quality, sustainable, and viable therapeutic option for these patients.

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Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

et al. 2016

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Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p < 0.001), and unplanned postoperative cardiac catheterization (p < 0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1-2.2, p = 0.014), 1.7 (95 % CI 1.2-2.3, p = 0.001), 1.8 (95 % CI 1.4-2.3, p < 0.001), and 2.0 (95 % CI 1.7-2.4, p < 0.001) times as long, respectively. These effects equated to an additional 4.5-7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.

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Quantification of Morbidity Associated with Congenital Heart Surgery

Cited by 4 publications

References 10 publications

Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease

Impact of hepatopathy in pediatric patients after surgery for complex congenital heart disease

Benefit From a Humanitarian Pediatric Congenital Heart Surgery Program Over a 10-Year Period

Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

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