Recommendations for Centers Performing Pediatric Heart Surgery in the United States

Abstract

Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.

Second harvest of Congenital Heart Surgery Database in Türkiye: Current outcomes

“…[ 13 , 14 ] According to the new “Recommendations for centers performing pediatric heart surgery in the United States” guideline, centers are divided into comprehensive care and essential care centers based on their case volume, and it was suggested that high-risk operations should be performed in comprehensive care centers. [ 12 ] Same recommendation is also evident for the European centers. [ 15 ] The same concept of concentrating the complex cases in specialized centers may be beneficial for our centers to improve patient care in Türkiye.…”

“…[ 11 ] Significant variation in outcomes also exists among centers in the USA. [ 12 ] High-volume centers demonstrate superior outcomes compared to other centers for complex neonatal and high-risk procedures. [ 13 , 14 ] According to the new “Recommendations for centers performing pediatric heart surgery in the United States” guideline, centers are divided into comprehensive care and essential care centers based on their case volume, and it was suggested that high-risk operations should be performed in comprehensive care centers.…”

Ethical Considerations in Fetal Cardiology

“…Patients have similarly reported significant burden to prenatal diagnosis including social barriers such as difficulty with appointment scheduling, lack of transportation or having a significant distance to travel for care, and difficulty having time away from work for appointments [ 27 ]. There is concern that these disparate trends may continue as cardiac care becomes increasingly complex, with recommendations for significant resources needed for comprehensive care, which naturally will lead to regionalization of CHD care [ 51 , 62 ].…”

“…There has been significant work on standardizing the data collection and reporting of outcomes for CHD, including adopting common nomenclature and a uniform dataset and mechanism of evaluating case complexity with collaboration between medical and surgical subspecialties [ 50 ]. Recent multi-specialty collaboration has put forth specific recommendations for both essential care and comprehensive care centers to better establish the basic requirements for centers caring for patients with CHD [ 51 ]. These detailed recommendations demonstrate the complexity of the care required for CHD patients and may aid fetal cardiologists to make better recommendations on delivery planning and care center expectations.…”