Outcomes from an interprovincial program of newborn open heart surgery

Abstract

ObjectivesTo determine 18-month neurodevelopmental outcome of survivors of complex open heart surgery at ≤6 weeks of age through an interprovincial program and to explore preoperative, operative, and postoperative outcome predictors. Study designOf 85 children from this inception cohort (21% mortality), 67 18-month-old survivors received multidisciplinary assessment including the Bayley Scales of Infant Development—II. Cumulative risk for adverse outcome was determined through univariate and multivariate analyses. ResultsSurvival of the 85 children included 23 of 23 after arterial switch, 16 of 26 after Norwood, six of six after total anomalous pulmonary venous drainage repair, and 22 of 30 after miscellaneous repair. Outcomes were as follows: in-hospital death, 14 (16%); postdischarge death, four (5%); motor/sensory disability, three (4%); motor/mental delay (<70), 21 (25%); and intact survivors, 43 (50%). Cohort mental (84±17) and motor (80±22) scores were lower for those with chromosomal abnormalities, 67±16 and 61±17, respectively. Fifty-five percent of the outcome variance was explained by duration of preoperative ventilation, 18%; genetic anomaly, 5%; intraoperative variables, 18%; and postoperative variables, 14%. ConclusionsRisk for adverse outcome is cumulative, with preoperative determinants contributing significantly to total variance. Potentially modifiable variables should be sought in an attempt to improve outcome.