Perioperative outcomes in congenital heart disease: a review of clinical factors associated with prolonged ventilation and length of stay in four common CHD operations

Abstract

ObjectivesPerioperative management strategies and outcomes for low-risk congenital heart disease (CHD) surgery vary between institutions. To date, no consensus exists on standardized management for pediatric patients undergoing cardiac surgery. This study seeks to benchmark the perioperative management of four common CHD lesions and explore clinical factors affecting postoperative outcomes. DesignA retrospective review of CHD procedures performed 2015-2020. SettingThe study was conducted at a single academic tertiary pediatric hospital. ParticipantsAll patients presenting for repair of ventricular septal defects (VSD), complete atrioventricular canal defects (CAVC), tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were reviewed. InterventionsDemographic and clinical data were collected; clinical outcomes were defined as postoperative length of ventilation (LOV) and hospital length of stay (LOS), divided into reference and prolonged course groups analyzed for variables associated with differences in outcomes. Measurements and Main Results931 patients were selected for review. Prolonged LOV and LOS in all cohorts were associated with longer operative, cardiopulmonary bypass and cross-clamp times; higher intraoperative requirements for inotropic support; more blood transfusions and higher opioid administration; lower pH pre-operatively and higher lactic acid post-operatively. Worse outcomes were associated with younger age in VSD, older age in TGA and lower weight in TOF and TGA. Worse outcomes were also associated with higher preoperative hematocrit in VSD and TOF and elevated preoperative blood glucose in VSD and TGA. ConclusionsA better understanding of clinical factors affecting outcomes may facilitate streamlining perioperative management strategies for pediatric patients undergoing low-risk cardiac surgery.