Abstract
Introduction: Acute limb ischemia (ALI) has been observed in infants with congenital heart disease (CHD). However, little is known about the demographics, clinical characteristics, and outcomes amongst these patients. Hypothesis: Infants with CHD with ALI are at significantly increased risk for adverse outcomes. Methods: We performed a retrospective cohort study of infants (<1 year of age) admissions for CHD using the 2003-2012 KID databases from the Healthcare Cost and Utilization Project. ALI and associated risk factors, treatments, and outcomes were defined using ICD-9 codes. Survey weights were utilized to estimate U.S. population-based estimates. Chi-square tests were used to compare groups. P < 0.05 indicated statistical significance. Results: We identified 368,398 observations of infants with CHD in the combined KID data, yielding an estimated average of 134,866 infant admissions per year for CHD in the U.S. Of these, 0.18% were diagnosed with ALI. The development of ALI was significantly associated with male sex (p = 0.0003) and single-ventricle CHD (p < 0.0001). Arterial line placement (RR 1.9 [1.67, 2.23]), cardiac catheterization (RR 14.7 [12.88, 16.87]), extracorporeal membrane oxygenation (RR 6.0 [5.24, 6.86]), and cardiac surgery (RR 8.5 [7.46, 9.73]) each increased the risk of ALI (p < 0.0001 for all). At least one of these procedures occurred in 73% of admissions with ALI as compared to 25% in admissions without ALI (p < 0.0001). Therapy for ALI (other than anticoagulation) varied, with a total of 174 admissions (18.1%) undergoing thrombolysis (4.0%), endovascular (4.0%), or an open surgical (9.3%) procedure. Admissions with ALI had a longer median length of stay (25.8 vs. 6.1 days, (p < 0.0001), and greater mortality (11.1% vs. 3.4%, p < 0.0001). Conclusions: Risk of ALI in infant visits with CHD significantly increases with procedural interventions and is associated with a prolonged hospital course and a 3.2-fold risk of mortality.
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