Related Experiment Video
Updated: Jul 18, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Mortality rates after surgery for congenital heart defects in children and surgeons' performance
J Stark1, S Gallivan, J Lovegrove
1Institute of Child Health, London, UK. jarda@freeuk.com
Insights
This study tracked mortality rates for paediatric congenital heart defect surgeries in the UK. While overall mortality was 4.0%, small patient numbers per surgeon hindered performance assessment.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Public Health
Background:
- A public inquiry highlighted the need for reliable mortality data in paediatric congenital heart defect (CHD) surgery.
- Assessing individual surgeon performance requires robust data on overall mortality rates.
Purpose of the Study:
- To gather and report mortality data for paediatric CHD operations over one year.
- To provide essential information for clinicians, researchers, policymakers, and the public.
Main Methods:
- Data collected on 1378 congenital heart defect operations across five UK departments (April 1997-March 1998).
- Operations represented approximately 36% of all UK procedures during the study period.
- Agreed criteria were used to classify operations into distinct subgroups.
Main Results:
- Overall mortality rate for all operations was 4.0% (95% CI 3.0-5.2).
- Specific mortality rates varied by procedure, with arterial-switch operations having 0% mortality and truncus arteriosus 28.6%.
- Surgeon mortality rates ranged from 1.6% to 6.9%, but small case numbers limited the ability to detect significant performance differences.
Conclusions:
- Participating departments demonstrated high standards of care for paediatric CHD.
- Assessing individual surgeon performance is challenging due to complex defects and small patient subgroups.
- Larger, multi-center datasets are necessary for robust quality standards and performance evaluation.
Background:
A public inquiry into surgery for paediatric congenital heart defects in Bristol, UK, underscored the need for reliable data on overall mortality rates, which would allow assessment of individual surgeons' performance. We aimed to gather and report such data for 1 year to provide information for clinicians, researchers, policy makers, and the general public.
Methods:
We collected data on all operations (1378) for congenital heart defects done by 11 surgeons in five departments in the UK between April 1, 1997, and March 31, 1998. These operations represented about 36% of all operations done in the UK during that time. Clearly defined criteria were agreed to classify operations into subgroups.
Findings:
The overall mortality rate for all operations was 4.0% (95% CI 3.0-5.2). No deaths occurred for 67 arterial-switch operations. Mortality rates for coarctation, ventricular septal defect, atrioventricular septal defect, Fallot, and truncus arteriosus operations were 1.1%, 0.6%, 3.6%, 2.3%, and 28.6%, respectively. Although overall mortality rates between surgeons varied (1.6-6.9%), no surgeon's were higher than the 95% CI. The numbers of operations done by individual surgeons were small, which led to wide confidence intervals and made the detection of differences in performance difficult.
Interpretation:
The participating departments seemed to reach high standards of care for children with congenital heart defects, although more data would be needed to assess performance of individual surgeons. The development of quality standards will be difficult because of the complexity of defects, the different types of operations, and few patients in each subgroup. Collection of larger sets of data for more patients and centres are needed.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure