Morbidity and Mortality of Pediatric Cardiac Surgery: About 84 Cases Operated at the Cardio-Pediatric Center Cuomo: Retrospective Study over 9 Months

Abstract

The general objective of this study was to evaluate the results of pediatric cardiac surgery over 9 months at the Cuomo cardio-pediatric center in Fann, Senegal. The specific objective was to assess morbidity and mortality over the same period after heart surgery in children. Our study focuses on 84 children with congenital or acquired heart disease. This is a retrospective single-center study that took place over a period of 9 months in 2017. An Excel sheet has been prepared to collect antecedents, clinical signs, paraclinical signs, as well as the operative protocol and the postoperative follow-up of the patients. A statistical analysis of the data was performed with the Stata software and the Excel spreadsheet. We found a male predominance with a sex ratio M/F of 1.1. We found dyspnea on 89.3% children and 94% had a heart murmur. The average of left ventricle ejection fraction (LVEF) was 66%. Congenital heart disease (58.3%) is represented by cyanogenic heart disease (15.5%), left-right shunts (33.3%) and obstructive malformations (9.5%). Acquired heart disease (41.7%) is represented by rheumatic heart disease (40.5%) and chronic constrictive pericarditis (1.2%). There was a complication in 46.4% of cases in intensive care and 4.8% of cases in hospital. Overall mortality was 2.4% with an operative mortality of 1.2% and a late mortality of 1.2%. Mitral disease was found only in the MORBIMORTALITY group (14.9% of cases) and this difference was significant (p=0.014). Among the procedures performed, there was more mitral surgery in the UNCOMPLICATED group (83.3% vs 30%). Whereas in the MORBIMORTALITY group there was more mitral valve replacement (70% vs 16.7%), this difference was significant (p=0.003). The average total length of hospital stay was 19 days. The length of stay in intensive care unit was longer in the MORBIMORTALITY group (5 vs 3 days, p=0.0027) and the duration of hospitalization (18 vs 11 days, p=0, 0004). At 3 months postoperative clinical improvement was noted in 85.7% of patients and there was no mortality. Surgery improves the quality of life for children who have congenital and acquired heart disease. This surgery is practicable in Senegal with satisfactory results. A better knowledge of the characteristics of patients with a complication or deceased can allow a better management in our center.