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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Clinical outcome of patients in a start-up congenital heart surgery program in Turkey
Ismihan Selen Onan1, Ersin Erek, Sertac Haydin
1Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey.
Insights
This study evaluated a new congenital heart surgery program, reporting a 10.7% mortality rate. Effective teamwork and collaboration are crucial for achieving good clinical outcomes in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Outcomes
- Surgical Program Development
Background:
- Establishing a new congenital heart surgery program requires careful evaluation of early clinical outcomes.
- Turkey's start-up program performed 616 operations between December 2009 and February 2012.
- Patient demographics included newborns, infants, and children/adolescents.
Purpose of the Study:
- To summarize and analyze the clinical outcomes of a newly established congenital heart surgery program.
- To assess the program's performance using risk adjustment in congenital heart surgery (RACHS-1) categories.
- To identify factors influencing mortality rates in pediatric cardiac surgery.
Main Methods:
- Retrospective analysis of 616 congenital heart surgeries.
- Utilized the Risk Adjustment in Congenital Heart Surgery (RACHS-1) model for risk stratification.
- Compared mortality rates across different age groups and procedure types.
Main Results:
- Overall mortality was 10.7% (66 out of 616 cases).
- Mortality rates varied significantly by RACHS-1 category, from 0% in Level I to 78.5% in Levels V and VI.
- Higher mortality was observed in neonates versus infants, infants versus children/adolescents, and palliative versus corrective procedures.
Conclusions:
- A start-up congenital heart surgery program can achieve acceptable results with strong teamwork and collaboration.
- Multidisciplinary collaboration among surgeons, anesthesiologists, cardiologists, perfusionists, and intensivists is vital for optimal outcomes.
- Risk stratification using models like RACHS-1 is essential for evaluating program performance and identifying areas for improvement.
Abstract:
This study summarizes the clinical outcome data of a start-up congenital heart surgery program in Turkey. Between December 2009 and February 2012, 616 operations have been performed in 132 newborns (22%), 260 infants (42%), and 224 children/adolescents (36%). Risk adjustment analysis was performed using the risk adjustment in congenital heart surgery (RACHS-1) risk assessment model. There were 66 mortalities (10.7%). According to the RACHS-1 categories, there were 51 cases in level I (8.2%) with no mortality (0%), 250 in level II (40.6%) with 11 (4.4%) mortalities, 199 in level III (32.3%) with 33 (16.5%) mortalities, 53 in level IV (8.6%) with 10 (18.8%) mortalities, 14 in level V and VI (2.2%) with 11 (78.5%) mortalities, and 49 cases (7.9%) out of the RACHS-1 categories with one (2.0%) mortality. Mortality was higher in neonates compared to infants, and in infants compared to children/adolescents. Mortality was higher in palliative procedures compared to corrective procedures. The data demonstrate that a start-up program with a relatively loaded surgical volume may achieve acceptable clinical results with a good teamwork. Collaboration of anesthesiologists, perfusionists, pediatric cardiologists, intensivists, and cardiovascular surgeons is necessary to provide a better outcome in congenital heart surgery.