Mortality In Paediatric Cardiac Surgery Research Articles

Risk factors for mortality in patients with hypoplastic left heart syndrome after the Norwood procedure.

Several studies have reported mortality risk factors associated with hypoplastic left heart syndrome (HLHS). However, these data are ambiguous and mainly focused on the independent effect of these factors. We examined both the independent and the cumulative effect of preoperative risk factors for poor outcome in patients undergoing the Norwood procedure. Moreover, we studied the risk factors associated with prolonged initial hospital stay in these patients. We performed a retrospective national 18-year observational study of preoperative risk factors for one-year, as well as total follow-up mortality or need for transplant in HLHS-patients (N = 99) born in Finland between 1 January 2004 and 31 December 2021. Overall, one-year survival was 85.6%. In a multivariable analysis, major extracardiac anomaly and being small for gestational age were significant predictors of one-year mortality or need for transplant. Aortic atresia was a predictor of total follow-up mortality. When analyzing the cumulative effect, the presence of two risk factors was associated with higher mortality. HLHS remains the defect with the highest procedural risks for mortality in paediatric cardiac surgery. From a prognostic point of view, recognition of independent preoperative risk factors as well as the cumulative effect of risk factors for mortality is essential.

Original Article--Surgical site infections following pediatric cardiac surgery in a tertiary care hospital: Rate and risk factors.

BackgroundSurgical site infections [SSIs] are the second most common type of healthcare-associated infections and leading cause of postoperative morbidity and mortality in pediatric cardiac surgery. This study aims to determine the rate of, risk factors for, and most common pathogen associated with the development of SSIs after pediatric cardiac surgery.MethodsPatients aged ≤14 years who underwent cardiac surgery at our tertiary care hospital between January 2010 and December 2015 were retrospectively reviewed.ResultsThe SSI rate was 7.8% among the 1510 pediatric patients reviewed. Catheter-associated urinary tract infection [CAUTI] [odds ratio [OR] 5.7; 95% confidence interval [CI] 2.3–13.8; P < 0.001], ventilator-associated pneumonia [VAP] [OR 3.2; 95% CI 1.4–7.2; P = 0.005], longer postoperative stay [≥25 days] [OR 4.1; 95% CI 2.1–8.1; P < 0.001], and a risk adjustment in congenital heart surgery [RACHS-1] score of ≥2 [OR 2.4; 95% CI 1.2–5.6; P = 0.034] were identified as risk factors for SSIs. Staphylococcus aureus was the most common pathogen [32.2%].ConclusionsSSI risk factors were longer postoperative stay, CAUTI, VAP, and RACHS-1 score of ≥2. Identification and confirmation of risk factors in this study is important in order to reduce the rate of SSIs following cardiac surgery.

External validation of the improving partial risk adjustment in surgery (PRAIS-2) model for 30-day mortality after paediatric cardiac surgery

ObjectiveIndependent temporal external validation of the improving partial risk adjustment in surgery model (PRAIS-2) to predict 30-day mortality in patients undergoing paediatric cardiac surgery.DesignRetrospective analysis of prospectively collected data.SettingPaediatric cardiac...

Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries. To evaluate perioperative complications rate, mortality related to complications, different patients' demographics, and procedural risk factors for perioperative complication and post-operative death. Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery. Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality - 8.1% among patients with only 1 perioperative complication, 35.3% - with 2 perioperative complications, and 42.1% - with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37). In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

A rare cause of pulmonary hemorrhage in the intraoperative period

The perioperative morbidity and mortality in pediatric cardiac surgery can be due to a multitude of factors. Timely identification of the problem helps in altering the treatment strategy and improving the outcome.

Comparison Between D901 Lilliput 1 and Kids D100 Neonatal Oxygenators: Toward Bypass Circuit Miniaturization

Progress in biomaterial technology and improvements in surgical and perfusion strategy ameliorated morbidity and mortality in pediatric cardiac surgery. In this study, we describe our clinical experience comparing performance of two neonatal oxygenators. From January 2002 to March 2011, 159 infants with less than 5 kg body weight underwent heart surgery. Ninety-four patients received a D901 Lilliput 1 oxygenator with standard bypass circuit (group A), while 65 received a D100 Kids with miniaturized bypass circuit (group B). Miniaturization consisted in shortened arterial, venous, cardioplegia, and pump-master lines. Priming composition consisted in Ringer's acetate solution with addition of albumin and blood, with target hematocrit of 24% or greater. In group B cardiopulmonary bypass (CPB) was vacuum-assisted and started with an empty venous line. Modified ultrafiltration and Cell-Saver blood infusion was routinely applied in both groups. Average ± standard deviation (SD) age at repair was 37 ± 38 days in group A and 59 ± 60 days in group B (P = 0.005). Average ± SD weight, height, and body surface area were 3.5 ± 0.7 kg, 52 ± 4 cm, and 0.22 ± 0.03 m(2) , respectively, in group A, and 3.7 ± 1 kg, 53 ± 5 cm, and 0.23 ± 0.02 m(2) , respectively, in group B (P = not significant [NS]). Male sex was predominant (55 vs. 58%, P = NS). Priming volume was 524 ± 67 mL (group A) and 337 ± 53 mL (group B) (P = 0.001). There were no statistical differences in hemoglobin at the start, during, and at the end of CPB, but group A required higher blood volume added to the prime (111 ± 33 vs. 93 ± 31 mL, P = 0.001). In group B, two surgical procedures were completed in total hemodilution. In group B, CPB time and aortic cross-clamp time were shorter than in group A (106 ± 52 vs. 142 ± 78 min and 44 ± 31 vs. 64 ± 31 min, respectively, P = 0.001). There were 16 hospital deaths in group A and 4 in group B (P = 0.04). Durations of mechanical ventilation and intensive care unit stay were 5.3 ± 3.2 vs. 4.1 ± 3.2 days (P = 0.02) and 6.5 ± 4.9 vs. 5.1 ± 3 days (P = 0.03), respectively. There were significant differences in inotropic score (1083 ± 1175 vs. 682 ± 938, P = 0.04) and blood postoperative transfusion (153 ± 226 vs. 90 ± 61 mL, P = 0.04). Twenty-seven patients in group A and 10 in group B presented with major adverse postoperative complications (P = 0.04). Use of neonatal oxygenators with low priming volume, associated with a miniaturized bypass circuit, seems to be a favorable strategy to decrease postoperative morbidity after cardiac surgery in neonates and infants.

Inflammatory and Hemostatic Response to Cardiopulmonary Bypass in Pediatric Population: Feasibility of Seriological Testing of Multiple Biomarkers

Perioperative myocardial and cerebral damages are the major determinants of postoperative morbidity and mortality in pediatric cardiac surgery. Cardiopulmonary bypass (CPB) causes alterations in the levels of biomarkers related to inflammation, tissue damage, and other tissue pathologies. Early and accurate evaluation of inflammation and tissue damage would therefore be clinically useful. Our objective is to assess the suitability of using Multi-Analyte Profiling (MAP) (Rules Based Medicine, Austin, TX, USA) in pediatric cardiac surgery as a potential surrogate marker of clinical outcome. MAP technology platform allowed us to analyze 90 different biomarkers using only 100µL of plasma to detect any changes in the levels of 90 biomarkers. Plasma samples (100µL) were collected at five different time points: 1. before midline incision; 2. on CPB for 3-5min; 3. at the end of CPB; 4. 1h after CPB; and 5. 24h after CPB. After removing the outliers, the average and standard deviation of the values obtained from the 10 patients were calculated for each time point. The average values of each biomarker at each time point were then compared to each other and to the baseline. The pilot protocol included 10 patients (ages from 3 months to 4 years old) with similar Jenkins risks stratifications who underwent nonpulsatile CPB. We detected changes in the levels of 90 biomarkers. Biomarkers were assessed in groups. Myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) were the earliest markers to rise with 49- and 18-fold increases 3-5min after the onset of CPB, respectively. The most striking increase was noted in the heart-type fatty acid-binding protein (FABP) levels. FABP increased 25, 193, 151, and 4-fold at time points 2, 3, 4, and 5, respectively. Surges in the novel markers of injury were followed by the markers of inflammation (i.e., C-reactive protein, interleukins) peaking at 24h after CPB. This pilot study shows that it is possible to measure 90 different biomarkers using only a very small sample of plasma to evaluate the effects of CPB. Novel markers of tissue injury (FABP, PAPP-A, or MPO) are the earliest markers to rise. Serial monitoring of multiple biomarkers may help to predict and improve outcomes after pediatric cardiac surgery.

Case Load and Mortality in Pediatric Cardiac Surgery

Case Load and Mortality in Pediatric Cardiac Surgery

Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data

Objectives: To determine whether mortality between 1991 and 1995 in hospitals in England carrying out surgery for congenital heart disease in children was associated with the annual volume of cases...

Serum lactate: a poor predictor of postoperative mortality in paediatric cardiac surgery

Initial serum lactate > 4.5 mmol/l has been found to predict mortality in children following cardiopulmonary bypass for open heart surgery [1]. Since in our experience initial lactate varies widely in both survivors (S) and non-survivors (NS), we hypothesized that persistent hyperlactataemia, or hyperlactataemia in combination with base deficit, might better predict postoperative mortality.