Congenital Heart Surgery Outcomes Research Articles

Congenital heart surgery outcomes in patients with positive respiratory viral swabs

ObjectiveTo examine whether or not viral positive patients experienced worse outcomes and assess differences in surgical outcomes between viral-positive patients with and without viral symptoms within 30 days of surgery. MethodsThis retrospective study reviewed charts of pediatric patients who underwent congenital heart surgery and routine viral testing at a single institution over a consecutive 3-year period (2017-2019). Patients with a history of heart transplants, pacemaker changes, or implants, and mediastinal washouts were excluded from the study. Surgical outcomes were compared by viral status and viral symptoms, using the Fisher exact and Wilcoxon rank sum tests. ResultsAmong 1041 patients, 374 patients underwent routine preoperative viral testing, with 107 patients testing positive and 267 testing negative for viral swabs before surgery. There were no significant differences observed in surgical outcomes by viral status, including no differences in mortality. Among the 107 patients with positive viral swabs before surgery, comparisons between 24 patients with viral symptoms and 83 without symptoms within 30 days of surgery detected no significant differences in mortality or complication rates. However, symptomatic versus asymptomatic patients had significantly longer postoperative stay (23.4 vs 13.4 days; P = .02) and intubation time (9.8 vs 4.9 hours; P = .004). ConclusionsPatients who test positive before congenital heart surgery and are asymptomatic beyond the incubation period may proceed to surgery with no further delay. Patients who are viral positive and symptomatic have a longer postoperative stay and intubation time. A prospective study is needed to assess the importance of routine viral testing.

Abstract 19043: Global Surgical Outcomes for Congenital Heart Disease: A Look at Databases

Introduction: Congenital heart diseases (CHDs) are the most common congenital anomalies, and almost one-third of patients require an intervention in the neonatal period or first year of life. Unlike low- and middle-income countries (LMICs), the survival of patients with CHD in high income countries is over 90%. The aim of this study was to compare the different congenital heart surgery (CHS) outcomes databases and analyze geographical variations. Methods: We analyzed the STS-CHSD (North America), the ECHSA, the ECHSA (Only Europe), and the IQIC for CHD (LMICs) databases between 2016 and 2019. All databases include aggregated data consisting of the 10-benchmark CHS and CHS grouped by mortality risk categories. For each database and condition, we extracted the number of participants, number of operations, postoperative length of stay (LOS), and mortality, comparing regional findings. Results: Compared to ECHSA, STS-CHSD database had more operations (32066 vs 14327) despite lower participant numbers. 50% of surgeries in LMIC were VSD closure, while the STS database reported the largest number of complex interventions. Mortality was lowest in North America for all the operations. LMICs had the shortest LOS, while North America had the longest LOS for almost all the benchmark operations. (Figure) However, the relevance of LOS is limited due to lack of data on demographic findings like age at surgery and gestation. Conclusions: The analysis of these three databases, accounting for limitations of aggregate data, highlight the differences in the CHS outcomes among world regions, reflecting the geographical difference of the population. Furthermore, it emphasizes the critical need to develop collaborative databases to improve global outcomes.

Abstract 16570: Benchmarking Risk-Adjusted Outcomes in Congenital Heart Surgery

Background: Robust models exist to predict risk-adjusted mortality following congenital heart surgery. It is known that underlying diagnosis modifies predicted risk of operations, and institution-level outcomes vary based on their unique case mix. We therefore evaluated risk-adjusted outcomes for a subset of diagnosis-procedure (D-P) combinations within the Society of Thoracic Surgeons' (STS) congenital heart surgery database (CHSD). Methods: A clinician panel identified the most frequently encountered D-P combinations in CHSD between 07/2017 and 06/2021. Candidate modeling techniques were compared in a random 80% development cohort. Model performance was assessed using internal and cross-validation calibration, discrimination plots and optimism adjusted C-statistics. The final selected model was evaluated in the 20% validation sample. Results: The chosen subset of D-P combinations represented 45,384 of 87,589 (52%) unique episodes of surgical care in CHSD during this time-period. The development cohort (36,350 episodes) had 1.8% mortality (667 deaths). All candidate models had excellent discrimination with C-statistics ranging from 0.862 to 0.876. The model with the best combination of discrimination, calibration, and clinical face validity was a modified version of the current STS mortality risk model. This version included all current risk model variables with the addition of indicator variables for D-P combinations. In the 20% validation sample (9,034 episodes), this model was well calibrated (Figure) and had excellent discrimination (C = 0.879). Conclusion: We describe a cohort of D-P combinations widely encountered in the STS CHSD. Further, we refined the existing STS CHSD risk model for application to these D-P dyads to derive empirical risk-adjusted benchmark outcomes. This approach will benefit quality improvement efforts at an institutional level and may have implications for publicly reporting congenital heart surgery outcomes.

Comparing apples to apples: Exploring public reporting of congenital cardiac surgery outcomes based on common congenital heart operations

ObjectiveWe sought to simplify reporting of outcomes in congenital heart surgery that compares well-defined patient groups and accommodates multiple stakeholder needs while being easily understandable. MethodsWe selected 19 commonly performed congenital heart surgeries ranging in complexity from repair of atrial septal defects to the Norwood procedure. Strict inclusion/exclusion criteria ensured the creation of 19 well-defined diagnosis/procedure cohorts. Preoperative, procedural, and postoperative data were collected for consecutive eligible patients from 9 centers between January 1, 2016, and December 31, 2021. Unadjusted operative mortality rates and hospital length of stay for each of the 19 diagnosis/procedure cohorts were summarized in aggregate and stratified by each center. ResultsOf 8572 eligible cases included, numbers in the 19 diagnosis/procedure cohorts ranged from 73 for tetralogy of Fallot repair after previous palliation to 1224 for ventricular septal defect (VSD) repair for isolated VSD. In aggregate, the unadjusted mortality ranged from 0% for atrial septal defect repair to 28.4% for hybrid stage I. There was significant heterogeneity in case mix and mortality for different diagnosis/procedure cohorts across centers (eg, arterial switch operation/VSD, n = 7-42, mortality 0%-7.4%; Norwood procedure, n = 16-122, mortality 5.3%-25%). ConclusionsReporting of institutional case volumes and outcomes within well-defined diagnosis/procedure cohorts can enable centers to benchmark outcomes, understand trends in mortality, and direct quality improvement. When made public, this type of report could provide parents with information on institutional volumes and outcomes and allow them to better understand the experience of each program with operations for specific congenital heart defects.

Contemporary Relationship Between Hospital Volume and Outcomes in Congenital Heart Surgery

BackgroundStudies examining the volume-outcome relationship in congenital heart surgery (CHS) are more than a decade old. Since then, mortality has declined, and case-mix adjustment has evolved. We determined the current relationship between hospital CHS volume and outcomes. MethodsPatients aged ≤18 years undergoing index operations in The Society of Thoracic Surgeons-Congenital Heart Surgery Database (2017-2020) were included. Associations between annual hospital volume and case-mix–adjusted operative mortality, major complications, failure to rescue (FTR), and postoperative length of stay (PLOS) were assessed using Bayesian hierarchical models, overall, by The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, and for the Norwood procedure. ResultsAcross 101 centers (76,714 index operations), median annual volume was 144 operations/y. Operative mortality was 2.7%. Lower-volume hospitals had higher mortality, with an apparent transition zone at ∼190 operations/y (95% credible interval [CrI], 115-450 operations/y), below which a sustained uptick in the estimated odds of death occurred. Odds of death compared with a 450 operations/y reference were 50 operations/y (odds ratio [OR], 1.84; 95% CrI, 1.41-2.37), 100 operations/y (OR, 1.37; 95% CrI, 1.08-1.71), 200 operations/y (OR, 0.92; 95% CrI, 0.1-1.18), 300 operations/y (OR, 0.89; 95% CrI, 0.76-1.04). The volume-outcome effect was more apparent for STAT 4 to 5 than STAT 1 to 3 operations. In the overall cohort, PLOS and complications were similar across hospital volumes, whereas FTR rates were higher at lower-volume hospitals. Lower-volume hospitals had worse outcomes after the Norwood procedure, most notably mortality and FTR. ConclusionsHospital volume is associated with mortality and FTR after CHS. The relationship is strongest for high-risk operations. These data can inform ongoing initiatives to improve CHS care.

Cirugía cardiovascular en España en el año 2021. Registro de intervenciones de la Sociedad Española de Cirugía Cardiovascular y Endovascular

This report provides the data corresponding to the cardiovascular surgery activity performed in Spain during 2021. The Spanish Registry is an anonymous and voluntary registry of aggregated data in which hospitals in the national territory have taken part, transferring their data to the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE). For the thirty-third consecutive year, the national activity data is reported. The 2021 registry may be of some value for analyzing the possible recovery of the cardiac surgery activity after the SARS-CoV-2 pandemic in our country.In 2021, 58 hospitals reported their activity compared to the 60 that shared their data in 2020. In total, 29,319 interventions were performed, with 19,229 major cardiac surgical procedures. Of these, 16,863 procedures were performed with cardiopulmonary bypass, 17,616 were indicated because of acquired disease and 1,613 for congenital disease. In addition, 2,637 peripheral vascular surgical interventions were registered.As in previous years, both congenital heart surgery and heart transplantation activity and outcomes will be reported in separate registries. Within the different types of major cardiac surgical procedures, the following were performed: 7,673 isolated valve procedures, 1,523 combined valve and coronary surgeries, 4,287 coronary revascularization procedures, 2,159 aortic surgeries, and 654 transcatheter valve implantations. Compared to 2020, we observed a general increase in activity, which was 7.9% compared to the previous year, but with a reduction of more than 12% compared to the mean of the previous 9 years (2012-2020).

Abstract 11922: The Independent Effects of Race/Ethnicity and Local Childhood Opportunity on Outcomes in Pediatric Congenital Heart Surgery

Background: Disparities in congenital heart disease (CHD) outcomes based on race/ethnicity and social determinants of health coexist. We sought to determine the independent effects of these factors on outcomes after pediatric CHD surgery. Methods: Pediatric Health Information System encounters age <18 years from 2003-2022 with ICD9/10 codes for CHD and cardiac surgery were linked to Zip Code-level Childhood Opportunity Index (COI), a score of neighborhood educational, environmental, and socioeconomic conditions. Independent effects of race/ethnicity and COI quintile on the outcome of death during surgical hospitalization were modeled with generalized estimating equations. Survival in neonates was modeled with Cox PH regression. Results: Of 193,028 encounters at 46 centers, Black, Asian, and Other groups had increased adjusted mortality compared to Non-Hispanic (NH) White. Compared to the middle COI quintile, the lowest quintile had a higher adjusted risk of death and the highest quintile was protective (Table 1a). In survival analysis of neonates (n=47,649; median follow-up 1.1 years), Black, Asian, and “Other” groups had worse survival than NH-White even after adjustment for COI quintile (Table 1b, Figure 1). Conclusions: Black, Asian, and “Other” children have increased in-hospital death after CHD surgery independent of local opportunity. Medium-term survival after neonatal surgery is similarly influenced, suggesting local opportunity is influential even at birth. Policies to improve local social determinants of health may improve outcomes, but persistent negative effects of minority status may be explained by other unmeasured forms of structural racism.

Effect of procedural volume on the outcomes of congenital heart surgery in Japan

ObjectivesThe present study developed a new risk model for congenital heart surgery in Japan and determined the relationship between hospital procedural volume and mortality using the developed model. MethodsWe analyzed 47,164 operations performed between 2013 and 2018 registered in the Japan Cardiovascular Surgery Database-Congenital and created a new risk model to predict the 90-day/in-hospital mortality using the Japanese congenital heart surgery mortality categories and patient characteristics. The observed/expected ratios of mortality were compared among 4 groups based on annual hospital procedural volume (group A [5539 procedures performed in 90 hospitals]: ≤50, group B [9322 procedures in 24 hospitals]: 51-100, group C [13,331 procedures in 21 hospitals]: 101-150, group D [18,972 procedures in 15 hospitals]: ≥151). ResultsThe overall mortality rate was 2.64%. The new risk model using the surgical mortality category, age-weight categories, urgency, and preoperative mechanical ventilation and inotropic use achieved a c-index of 0.81. The observed/expected ratios based on the new risk model were 1.37 (95% confidence interval, 1.18-1.58), 1.21 (1.08-1.33), 1.04 (0.94-1.14), and 0.78 (0.71-0.86) in groups A, B, C, and D, respectively. In the per-procedure analysis, the observed/expected ratios of the Rastelli, coarctation complex repair, and arterial switch procedures in group A were all more than 3.0. ConclusionsThe risk-adjusted mortality rate for low-volume hospitals was high for not only high-risk but also medium-risk procedures. Although the overall mortality rate for congenital heart surgeries is low in Japan, the observed volume-mortality relationship suggests potential for improvement in surgical outcomes.

Center Volume Impacts Readmissions and Mortality after Congenital Cardiac Surgery

To characterize the relationship between surgical volume and postoperative outcomes in congenital heart surgery, we used a national cohort to assess the costs, readmissions, and complications in children undergoing cardiac operations. The Nationwide Readmissions Database was used to identify pediatric patients (≤18years) undergoing congenital cardiac surgery from 2010 to 2017. Hospitals were categorized based on deciles and tertiles of annual caseload with high-volume categorized as the highest tertile of volume. Multivariable regression models adjusting for patient and hospital characteristics were used to study the impact of volume on 30-day nonelective readmission, mortality, home discharge, and resource use. Of an estimated 69 448 hospitalizations included for analysis, 56 672 (82%) occurred at high-volume centers. After adjustment for key clinical factors, each decile increase in volume was associated with a 25% relative decrease in the odds of mortality, a 14% decrease in the odds of nonhome discharge, and a 4% relative decrease in the likelihood of 30-day nonelective readmission. After risk adjustment, each incremental increase in volume decile was associated with a one-half-day decrease in the hospital length of stay, but did not alter costs of the index hospitalization. However, after including all readmissions within 30days of the index discharge, high-volume centers were associated with significantly lower costs compared with low-volume hospitals. Increased congenital cardiac surgery volume is associated with improved mortality, reduced duration of hospitalization, 30-day readmissions, and resource use. These findings demonstrate the inverse relationship between hospital volume and resource use and may have implications for the centralization of care for congenital cardiac surgery.

Does It Measure Up?

Measuring outcomes in pediatric cardiac care has been one of the more widespread, and at the same time controversial and often polarizing, quality improvement initiatives undertaken in the medical field. Risk models, such as the Society of Thoracic Surgeons Congenital Heart Surgery Risk Model, have been developed to account for comorbidities while predicting the expected mortality for a given surgical encounter. In this issue of the journal, Bertsimas and colleagues report on machine learning approaches to predict adverse outcomes in congenital heart surgery using the European Congenital Heart Surgeons Association's congenital database. A head-to-head comparison of machine learning models and the currently available risk models utilizing the same data set are required to better understand the strengths and weaknesses of each of these approaches. Such a focused analysis will shed light on future approaches for risk modeling, which will undoubtedly continue to benefit from the guidance provided by expert clinical intuition.

Adverse Outcomes Prediction for Congenital Heart Surgery: A Machine Learning Approach.

Risk assessment tools typically used in congenital heart surgery (CHS) assume that various possible risk factors interact in a linear and additive fashion, an assumption that may not reflect reality. Using artificial intelligence techniques, we sought to develop nonlinear models for predicting outcomes in CHS. We built machine learning (ML) models to predict mortality, postoperative mechanical ventilatory support time (MVST), and hospital length of stay (LOS) for patients who underwent CHS, based on data of more than 235,000 patients and 295,000 operations provided by the European Congenital Heart Surgeons Association Congenital Database. We used optimal classification trees (OCTs) methodology for its interpretability and accuracy, and compared to logistic regression and state-of-the-art ML methods (Random Forests, Gradient Boosting), reporting their area under the curve (AUC or c-statistic) for both training and testing data sets. Optimal classification trees achieve outstanding performance across all three models (mortality AUC = 0.86, prolonged MVST AUC = 0.85, prolonged LOS AUC = 0.82), while being intuitively interpretable. The most significant predictors of mortality are procedure, age, and weight, followed by days since previous admission and any general preoperative patient risk factors. The nonlinear ML-based models of OCTs are intuitively interpretable and provide superior predictive power. The associated risk calculator allows easy, accurate, and understandable estimation of individual patient risks, in the theoretical framework of the average performance of all centers represented in the database. This methodology has the potential to facilitate decision-making and resource optimization in CHS, enabling total quality management and precise benchmarking initiatives.

Racial and socioeconomic disparities in congenital heart surgery: A research article.

Though the modern era has proven to be reassuring with the advancement of perioperative care leading to improved survival, congenital heart disease (CHD) continues to underscore its significance in the lives of newborns and families worldwide. Particularly, CHD has disproportionately afflicted vulnerable minorities such as Black and Hispanic populations from the standpoint of ethnic disparities in mortality following heart surgery, increased resource utilization, and longer durations of stay. This study aims to identify and provide insight regarding the relationships between the aforementioned factors to develop targeted strategies of intervention to mitigate the outcomes for patients of these specific populations. Free, current peer-reviewed literature from databases such as the American Heart Association, The European Heart Journal, Science Direct, and PubMed regarding CHD, racial disparities, and socioeconomic variances were accessed. The study was narrowed to a patient population including only infants without chromosomal anomalies or those that passed away before hospital discharge. Having private insurance and maternal education showed positive correlations with positive outcomes of patients post congenital heart surgery. Teaching hospitals were linked with increased mortality and complications. Male infants showed higher rates of complications. Hispanics had increased odds of complications. Black patients had increased risk for failures in being rescued. Race plays a major role in the disparities in CHD, it is imperative to evaluate the socioeconomic contributors, surgical efforts, and provisions in place regarding minority patients. The apparency of these disparities, and willingness to invoke changes in practice has the potential for improvements in outcomes for these patients.

Impact of COVID-19 Pandemic in a Pediatric and Congenital Cardiovascular Surgery Program in Brazil.

Introduction:The coronavirus disease 2019 (COVID-19) has negatively impacted healthcare services worldwide. We hypothesized that the pandemic would affect our case mix and mortality. Our objective was to study this impact.Methods:We retrospectively studied all patients who underwent congenital heart surgeries from March 21st to August 21st in 2019 and 2020 using the institutional electronic database. We compared demographic data, preoperative and postoperative length of stay (LOS), risk stratification using Risk Adjustment for Congenital Heart Surgery (RACHS) classification and outcomes in both periods.Results:We observed a 66.7% decrease in our surgical volume (285 × 95 patients). Patients operated in the pre-pandemic period were older (911.3 [174.8 - 5953.8] days-old) compared to the pandemic period (275 days-old; P<0.05). When the case mix was compared between periods, the percentage of neonatal surgery was increased in the pandemic era (8% × 21.1%; P<0.05), and the number of RACHS 1-2 surgeries decreased significantly (60.7 × 27.4%; P<0.05). Preoperative LOS was increased in the pandemic period (1.2 × 7 days; P=0.001). There was no significant increment in mortality (P=0.1). Two patients tested positive for COVID-19 in the postoperative period and both died.Conclusion:Our program observed a sudden decrease in surgical volume and a consequent increase in surgical complexity. There was a non-significant increment in mortality.

Weight impacts 1-year congenital heart surgery outcomes independent of race/ethnicity and payer.

Body mass index, race/ethnicity, and payer status are associated with operative mortality in congenital heart disease (CHD). Interactions between these predictors and impacts on longer term outcomes are less well understood. We studied the effect of body mass index, race/ethnicity, and payer on 1-year outcomes following elective CHD surgery and tested the degree to which race/ethnicity and payer explained the effects of body mass index. Patients aged 2-25 years who underwent elective CHD surgery at our centre from 2010 to 2017 were included. We assessed 1-year unplanned cardiac re-admissions, re-interventions, and mortality. Step-wise, multivariable logistic regression was performed.Of the 929 patients, 10.4% were underweight, 14.9% overweight, and 8.5% obese. Non-white race/ethnicity comprised 40.4% and public insurance 29.8%. Only 0.5% died prior to hospital discharge with one additional death in the first post-operative year. Amongst patients with continuous follow-up, unplanned re-admission and re-intervention rates were 14.7% and 12.3%, respectively. In multivariable analyses adjusting for surgical complexity and surgeon, obese, overweight, and underweight patients had higher odds of re-admission than normal-weight patients (OR 1.40, p = 0.026; OR 1.77, p < 0.001; OR 1.44, p = 0.008). Underweight patients had more than twice the odds of re-intervention compared with normal weight (OR 2.12, p < 0.001). These associations persisted after adjusting for race/ethnicity, payer, and surgeon.Pre-operative obese, overweight, and underweight body mass index were associated with unplanned re-admission and/or re-intervention 1-year following elective CHD surgery, even after accounting for race/ethnicity and payer status. Body mass index may be an important modifiable risk factor prior to CHD surgery.

Abstract 13699: Cyclohexanone Contamination of Medical Plastics is Associated With Worse Congenital Heart Surgery Outcomes

Introduction: Cyclohexanone, an industrial medical plastic fabrication contaminant, can leach from medical plastics including the cardiopulmonary bypass (CPB) circuit. Effects of neonatal perioperative cyclohexanone exposure on hospital-based outcomes have not been explored. Hypothesis: We hypothesize that serum cyclohexanone during congenital heart surgery with CPB is associated with worse morbidity. Methods: The study was a secondary analysis of 107 neonates enrolled in the NHLBI-funded Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass trial. Blood samples were collected preoperatively, post-CPB, and 12 hours postoperatively, and concentrations of cyclohexanone and its metabolites were quantified using mass spectrometry. Using the geometric mean of cyclohexanone concentrations, the effects of an interquartile range (IQR) increase in concentration on hospital-based outcomes was assessed using adjusted linear and Poisson regression, for continuous and dichotomous outcomes, respectively. Estimates were reported as % differences (linear regression) or relative risks (Poisson regression) with 95% confidence intervals. Results: In adjusted analyses, an IQR increase in mean cyclohexanone concentration was associated with greater time spent on mechanical ventilation (40.1%: 7.34%, 82.9%), in the ICU (20.1%: 1.36%, 42.2%), and in the hospital (20.8%: 3.28%, 41.3%), and less time spent alive and out of the hospital 90 days post-surgery (-17%: -30.9%, -0.36%). An IQR increase in mean cyclohexanone was associated with a 61% (RR: 1.61; 1.19, 2.17) greater risk of the trial primary morbidity-mortality composite outcome (death, cardiac arrest, ECMO, renal or hepatic insufficiencies, and lactic acidosis). An IQR increase in mean cyclohexanone metabolites was associated with a 29% (RR: 1.29; 1.07, 1.55) greater risk of developing low cardiac output syndrome. Conclusions: This study showed that in neonates, circulating cyclohexanone was associated with unfavorable hospital-based outcomes following cardiac surgery with CPB, suggesting that medical plastic contamination may contribute to morbidity. Therefore, reducing exposure to cyclohexanone perioperatively may improve congenital heart surgery outcomes.

Abstract 14639: An Integrated Heart Center Model Improves Outcomes After Congenital Heart Surgery

Introduction: Contemporary experience suggests that congenital heart surgery (CHS) outcomes are optimized with an integrated, focused, and multidisciplinary program. In July 2018, our institution transitioned to an integrated Heart Center (IHC) model with new dedicated surgical, cardiac intensive care, anesthesiology, perfusion, and nursing teams. Multidisciplinary protocols and quality processes were implemented. This transition provides an unusual opportunity to evaluate the impact of an IHC model on outcomes after CHS. Methods: Patients who underwent index CHS 10/16-3/20 were included. The cohort was divided into 2 groups: historical (first 21 mo) and IHC (second 21 mo). Cases were evaluated using STAT category, mortality, and other outcomes as defined by Society of Thoracic Surgeons criteria. Descriptive statistics, univariate analyses, and multivariable regression models were used. Results: The cohort included 627 patients (historical: 230, IHC: 396, 72% increase). Numbers of STAT 4 and 5 cases increased 174% (31 to 85) and 900% (1 to 10), respectively. Neonatal cases increased 100%, infants 138%, and adults 622%. Despite an increase in complexity, perioperative mortality decreased from 3.5% to 0.5% (p=0.007) (Table). Median postoperative length of stay (LOS) increased from 5[4-10] to 7 [4-18] days (p&lt;0.001). 30-day readmission rates increased from 8.6% to 14% (p=0.048). After adjusting for patient characteristics and STAT category, perioperative mortality remained significantly lower (OR 3.4, 95% CI 1.1-5.6, p=0.004), postoperative LOS was longer (RR 6.9, 95% CI 2.6-11.1, p=0.002), and 30-day readmission was not different (p=0.7). Conclusions: Implementation of an IHC model improves perioperative survival after CHS, coupled with an increase in volumes and complexity. CHS care should be delivered as part of a dedicated and multidisciplinary IHC model.

Outcome of congenital heart surgery for patients with Down Syndrome

Outcome of congenital heart surgery for patients with Down Syndrome

Selected 2019 Highlights in Congenital Cardiac Anesthesia

This article is a review of the highlights of pertinent literature published in 2019, which is of interest to the pediatric cardiac anesthesiologist. After a search of the United States National Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2019. The authors of this manuscript considered the following topics noteworthy and were included in this review: advances in pediatric heart transplantation, blood management in pediatric cardiac surgery, the impact of nutrition on outcomes in congenital heart surgery, and the use of vasopressin in patients after Fontan palliation.

Improving National Outcomes in Congenital Heart Surgery: The Time Has Come for Regionalization of Care.

Recently there have been several high-profile articles in the national media reporting on US congenital heart surgery programs, which have led in part to closure or curtailing of surgical services of at least 5 programs. These articles stemmed from concerns raised by families and practitioners regarding program outcomes and lack of transparency, which led to news media investigations and reported findings of mortality and complication rates that exceeded national norms. These cases highlight what has been well-documented for many years, the wide variability in care delivery, practices, and outcomes across US centers performing congenital heart surgery (1).

Technical Performance Score Predicts Perioperative Outcomes in Complex Congenital Heart Surgery Performed in a Small-to-Medium-Volume Program.

As the quality of surgical outcomes depend on many factors, the development of validated tools to assess the different aspects of complex multidisciplinary teams' performance is crucial. The Technical Performance Score (TPS) has only been validated to correlate with outcomes in large-volume surgical programs. Here we assess the utility of TPS in correlation to perioperative outcomes for complex congenital heart surgeries (CHS) performed in a small-to-medium-volume program. 673 patients underwent CHS from 4/2012 to 12/2017 at our institution. Of those, 122 were STAT 4 and STAT 5. TPS was determined for each STAT 4 and STAT 5 operation using discharge echocardiogram: 1 = optimal, 2 = adequate, 3 = inadequate. Patient outcomes were compared including mortality, length of stay, ventilation times, and adverse events. 69 patients (57%) were neonates, 32 (26%) were infants, 17 (14%) were children, 4 (3%) were adults. TPS class 1 was assigned to 85 (70%) operations, TPS class 2 was assigned to 25 (20%) operations, and TPS class 3 was assigned to 12 (10%) operations. TPS was associated with re-intubation, ICU length of stay, postoperative length of stay, and mortality. TPS did not correlate with unplanned 30-day readmissions, need for reoperation, and inotropic score. Technical performance score was associated with perioperative outcomes and is a useful tool to assess the adequacy of repair for high complexity CHS in a small-to-medium-volume surgical program. TPS should be a part of program review in congenital heart programs of all sizes to identify strategies that may reduce postoperative morbidity and potentially improve long-term outcomes.