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Mid-term follow-up after multiple system organ failure following cardiac surgery in children
R Heying1, M C Seghaye, R G Grabitz
1Department of Paediatric Cardiology, Aachen University of Technology, Germany. heying@uni-duesseldorf.de
Insights
Children surviving multiple system organ failure after congenital heart surgery show mild mid-term issues, except for neurological deficits. Further research with control groups is needed to understand long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Pediatric Critical Care Medicine
- Pediatric Surgery
Background:
- Multiple system organ failure (MSOF) is a severe complication following pediatric cardiac surgery.
- Long-term outcomes for children surviving MSOF after cardiac operations are not well understood.
Purpose of the Study:
- To evaluate the mid-term clinical and functional sequelae in children who survived MSOF after cardiac surgery for congenital heart defects.
Main Methods:
- A cross-sectional follow-up study was conducted on 11 children (20-126 months old).
- Evaluations included cardiac, pulmonary, renal, hepatic, neurological, and psychological function tests.
- Follow-up occurred 12-76 months post-surgery.
Main Results:
- All patients maintained adequate cardiac function.
- Abnormalities were noted in lung mechanics (3/11), renal function (2/11), and liver enzymes/coagulation (6/11 and 7/11, respectively).
- Neurological sequelae (diplegia, mental retardation) and developmental delays (motor, speech) were observed in some children.
Conclusions:
- Mid-term sequelae of MSOF after pediatric cardiac surgery are generally mild, with neurological impairment being a notable exception.
- Longer-term follow-up studies, including control groups, are essential to fully characterize outcomes.
Abstract:
Multiple system organ failure after cardiac surgery in children is a severe complication with unknown mid- and long-term sequelae. We therefore evaluated 11 children (aged 20-126 mo, median: 67 mo) having survived multiple system organ failure after cardiac operations for congenital cardiac defects in a cross-sectional follow-up study 12-76 mo (median: 32 mo) after surgery. Clinical and laboratory examinations included cardiac, pulmonary, renal, hepatic, neurological and psychological function tests. All patients had adequate cardiac function. Lung mechanics were abnormal in three children and glomerular renal function was abnormal in two patients. Slight elevation of gamma-glutamyl transpeptidase and coagulation factor deficiency was present in six and seven patients, respectively (five of whom had undergone the Fontan operation). Severe neurological sequelae such as diplegia (n = 1) and mental retardation (n = 1) were observed in two patients. In addition, five children presented delayed motor, graphomotor and/or speech development. Two children were found to have abnormal intelligence. We conclude that with the exception of neurological impairment, mid-term sequelae of multiple system organ failure after cardiac surgery in children are mild. However, longer follow-up using an appropriate control group is mandatory.