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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Care models and associated outcomes in congenital heart surgery
Danielle S Burstein1, Jeffrey P Jacobs, Jennifer S Li
1Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA. sara.pasquali@duke.edu
Insights
Dedicated pediatric cardiac intensive care units (CICU) showed no overall difference in outcomes for children after heart surgery. However, a survival benefit was observed in specific patient subgroups undergoing complex procedures.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Health Services Research
Background:
- A growing trend exists for caring for pediatric cardiac surgery patients in dedicated pediatric cardiac intensive care units (CICUs).
- The impact of dedicated CICUs on patient outcomes remains unclear.
- This study investigates the association between CICU care and postoperative outcomes.
Purpose of the Study:
- To evaluate postoperative outcomes, including mortality, length of stay, and complications, in children undergoing heart surgery.
- To compare outcomes between patients treated in dedicated pediatric cardiac intensive care units (CICUs) versus other intensive care unit (ICU) models.
Main Methods:
- Utilized data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007-2009).
- Included 20,922 patients from 47 centers, with 25 centers having a CICU.
- Performed multivariable analysis adjusting for center volume, patient factors, and surgical risk category.
Main Results:
- No significant difference in overall mortality was found between CICUs and other ICUs (OR: 0.88; 95% CI: 0.65-1.19).
- CICUs were associated with lower mortality in a subgroup of patients (Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category 3), particularly for atrioventricular canal repair and arterial switch operations.
- No differences in length of stay or complication rates were observed overall or in stratified analyses.
Conclusions:
- The presence of a dedicated pediatric cardiac intensive care unit (CICU) did not demonstrate a significant difference in overall postoperative morbidity or mortality for children undergoing heart surgery.
- A potential survival benefit for CICUs may exist within specific patient subgroups, warranting further investigation.
Objective:
Recently, there has been a shift toward care of children undergoing heart surgery in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on patient outcomes is unclear. We evaluated postoperative outcomes associated with a CICU versus other ICU models.
Patients And Methods:
Society of Thoracic Surgeons Congenital Heart Surgery Database participants (2007-2009) who completed an ICU survey were included. In multivariable analysis, we evaluated outcomes associated with a CICU versus other ICUs, adjusting for center volume, patient factors, and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery surgical risk category.
Results:
A total of 20 922 patients (47 centers; 25 with a CICU) were included. Overall unadjusted mortality was 3.8%, median length of stay was 6 days (interquartile range: 4-13), and 21% had 1 or more complications. In multivariable analysis, there was no difference in mortality comparing CICUs versus other ICUs (odds ratio: 0.88 [95% confidence interval: 0.65-1.19]). In stratified analysis, CICUs were associated with lower mortality only among those in Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category 3 (odds ratio: 0.47 [95% confidence interval: 0.25-0.86]), primarily related to atrioventricular canal repair and arterial switch operation. There was no difference in length of stay or complications overall or in stratified analysis.
Conclusions:
We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .
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