Risk analysis of operative mortality in neonates with congenital heart disease

Abstract

Objective To analyze the risk factors in the operative mortality in neonates with congenital heart disease. Methods The surgical outcomes of congenital heart defects in 231 neonates at Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University of Medicine, during Jan.2011 and Dec.2013 were detected for retrospectively.Patients were analyzed according to Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1). The age, weight at operation, emergency operation, cardiopulmonary bypass, single ventricle surgery, and RACHS-1 score were detected for risk assessments. Results Overall mortality of congenital heart defect in neonates was 9.96%(23/231 cases). The top three procedures for high mortality were single ventricle palliative surgery (25.00%, 7/28 cases), corrective operation of interrupted aortic arch (21.43%, 3/14 cases), and arterial switch operation with ventricular septum defect repair (13.95%, 6/43 cases). There was only 1 case of pulmonary atresia with intact ventricular septum repair, and the case was not classified into high mortality category.With the elevation of RACHS-1, the mortality increased.The mortality rate was 6.67%(2/30 cases) in RACHS-1 as category 2, 6.84%(8/117 cases) in 3, 13.75%(11/80 cases) in 4, and 50.00%(2/14 cases) in 6.Multivariable analysis of risk factors for death showed that single ventricle palliative operation, body weight less than 3 000 g, and RACHS-1 were independent risk factors for mortality. Conclusions This study shows the surgical mortality in neonates with congenital heart defect is still high.Further prospective analysis of specific treatment strategies for high risk patients above was needed and the strategy for single ventricle ope-ration in neonates should be optimized. Key words: Congenital heart defect; Cardiac surgery; Risk factors; Infant, newborn