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Persistent institutional difficulties in surgery for transposition of the great arteries in guatemala: analysis with
Juan Leon-Wyss1, Mauro Lo Rito, Joaquin Barnoya
1Pediatric Cardiac Surgery Unit of Guatemala (UNICARP), Guatemala, Centro America.
Insights
Neonatal cardiac surgery for transposition of the great arteries (TGA) in Guatemala had high mortality due to late referrals. Early diagnosis and prompt surgical referral are crucial for improving outcomes in complex congenital heart disease.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Surgical Outcomes Analysis
Background:
- Neonates with complex congenital cardiac lesions in Guatemala face inadequate management.
- Transposition of the great arteries (TGA) is a critical congenital heart defect requiring timely surgical intervention.
Purpose of the Study:
- To evaluate surgical outcomes for neonates with TGA in Guatemala between 1997 and 2009.
- To assess the impact of operative complexity on mortality using the Aristotle scores.
Main Methods:
- Retrospective review of 79 patients undergoing surgery for TGA.
- Categorization into arterial switch operation (ASO) and atrial switch operation (ATSO) groups.
- Application of Aristotle Basic Complexity (ABC) and Comprehensive Complexity (ACC) scores to assess surgical complexity and quality of care.
Main Results:
- High in-hospital mortality rates: 47% for ASO and 25% for ATSO.
- Significant differences in complexity scores (ABC and ACC) between survivors and nonsurvivors.
- Late presentation and increased preoperative risk factors were noted in a substantial proportion of patients.
Conclusions:
- Low surgical volume and high mortality for TGA in Guatemala during the study period.
- Late referral and diagnosis significantly impact outcomes for neonates with TGA.
- Strategies for improvement include nationwide early diagnosis and prompt referral to specialized centers.
Abstract:
Background. Neonates with complex congenital cardiac lesions are largely inadequately managed in Guatemala. Methods. Between 1997 and 2009, 79 patients who underwent operations for transposition of the great arteries were identified; 51 (63.3%) had an arterial switch operation (ASO) and 28 (36%) an atrial switch operation (ATSO). The Aristotle Basic Complexity score (ABC score) and the Aristotle Comprehensive Complexity score (ACC score) have been used to aid in the evaluation of quality of care associated with pediatric cardiac surgery by adjusting for operative complexity. Results. In-hospital mortality was 47% for the ASO and 25% for the ATSO group; 36.7% were beyond 1 month of age and many exhibited increased preoperative risk factors. The mean ABC score was 9.75 ± 0.89 and the ACC score was 12.12 ± 2.7, with a mean 2.36-point increase (P < .05). Comparing survivors and nonsurvivors with both scores, significant differences were identified (ABC: P < .04 and ACC: P < .02). Conclusion. During this 13-year period, a low volume of surgery for transposition of the great arteries (TGA) was performed at our institution with a relatively high surgical mortality. Many patients with TGA in Guatemala are either never referred for surgery or referred late. Strategies to improve outcomes for neonates with TGA in Guatemala must include increases in early diagnosis countrywide and prompt referral to our unit. Based on the larger number of neonates with TGA that would be referred to our center, we anticipate that this strategy should substantially improve surgical outcomes and favor overall team-related skills.
