Surgical Mortality in Pediatric Congenital Heart Surgery: 10-Year Experience in a Chilean Cardiac Surgery Center

Baquerizo P, Clavería C, Becker P, Ibáñez S, Villablanca P, Cerda J, González R, Castillo A and Valderrama P*

Department of Pediatrics, Pontificia Universidad Católica de Chile, Chile Department of Pediatric Cardiology, Division of Pediatrics, Pontificia Universidad Católica de Chile, Chile Department of Cardiovascular Surgery, Pontificia Universidad Catolica de Chile, Chile Pontificia Universidad Católica de Chile, Chile Department of Public Health, Pontificia Universidad Católica de Chile, Chile Pediatric Intensive Care Unit, Division of Pediatrics, Pontificia Universidad Católica de Chile, Chile Department of Pediatrics, Universidad Finis Terrae, Chile

^*Correspondance to: Paulo Valderrama 

 PDF  Full Text DOI: 10.25107/2474-1647.3687

Abstract

Background: Cardiac surgery is one fundamental pillars in the treatment of patients with Congenital Heart Disease (CHD). Various scales have stratified the risk of Surgical Mortality (SM). Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) scale classifies the different procedures according to their complexity and associated mortality risk, comparing SM of the same center or with peers according to the complexity of the surgery performed. Objectives: To determine the current overall SM for general cardiac surgery in pediatric patients with CHD, according to the RACHS-1 stratification and to compare it with the results published at the national level. Methods: Descriptive study. Patients under 18 years of age who underwent surgery for CHD at the Hospital Clínico de la Pontificia Universidad Católica de Chile between August 2010 to July 2020 were analyzed. Risk stratification was performed by RACHS-1. Ductus ligation in premature babies, surgery for acquired heart diseases and heart transplants were excluded.Results were compared with previously published results of the same institution for the period 2000-2010. Results: 2,039 surgeries were performed in 1,589 patients. 56.7% of the patients were men with a median age of 6 months (range 0 days - 17 years). The main diagnoses were: ventricular septal defect 17.8% and tetralogy of Fallot 14.3%. 19.2% were syndromatic, of which 13.9% had Down syndrome. 89.6% of the surgeries were with Cardiopulmonary bypass with a mean duration of 121.8 min. Overall SM was 3.3%. Stratified by RACHS-1 score surgical mortality was: Category 1: 1.6%, Category 2: 1.3%, Category 3: 3.5%, Category 4: 4.0%, Category 5: 33.3%, Category 6: 15.5%. For overall surgical procedures: 69.7% were operated on during the first year of life and 90% before the age of 6 years, 75% went to the biventricular pathway. Compared to our previous 10-year study, the SM decreased significantly from 5.9% to 3.3% (p<0.01), despite an increase in the number and complexity of surgeries, especially in RACHS 3 and 4 groups. Conclusion: At our Institution, overall surgical mortality of congenital heart surgery decreased in the last 10 years from 5.9% to 3.3%, despite an increase in the number of procedures and their complexity compared to a similar period published at the same center previously.

Keywords

Mortality; Congenital heart disease; Congenital heart surgery

Cite the article

Baquerizo P, Clavería C, Becker P, Ibáñez S, Villablanca P, Cerda J, et al. Surgical Mortality in Pediatric Congenital Heart Surgery: 10-Year Experience in a Chilean Cardiac Surgery Center. Clin Surg. 2024; 9: 3687..