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National experience with pediatric surgical aortic valve repair: A Pediatric Health Information System analysis
Kevin Kulshrestha1, Jason W Greenberg1, John T Kennedy1
1Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, The Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Surgical aortic valve repair in pediatric patients shows success, but infants, previously hospitalized children, and those with heart failure face higher risks of mortality and readmission. Further research is needed to improve outcomes for these vulnerable groups.
Area of Science:
- Pediatric Cardiac Surgery
- Valvular Heart Disease Management
- Health Outcomes Research
Background:
- Surgical aortic valve repair in pediatric patients is complex, with varying outcomes.
- Understanding national trends and risk factors is crucial for improving care.
- The Pediatric Health Information System (PHIS) database offers a valuable resource for this analysis.
Purpose of the Study:
- To characterize the national experience with surgical aortic valve repair in pediatric patients.
- To identify risk factors associated with adverse outcomes, including reintervention, readmission, and in-hospital mortality.
- To evaluate the impact of patient demographics, comorbidities, and center volume on surgical outcomes.
Main Methods:
- A retrospective analysis of 5,582 pediatric patients (aged ≤17 years) undergoing open aortic valve repair from 2003 to 2022 using the Pediatric Health Information System database.
- Outcomes assessed included reintervention during the index admission, readmission, and in-hospital mortality.
- Logistic regression was employed to identify predictors of in-hospital mortality.
Main Results:
- Infants (26% of cohort) experienced the highest rates of reintervention (3%), readmission (53%), and in-hospital mortality (10%).
- Previously hospitalized patients and those with heart failure also showed significantly higher risks for adverse outcomes.
- High-volume centers performed half of all procedures, suggesting a concentration of expertise.
Conclusions:
- Surgical aortic valve repair is feasible in pediatric patients, with a majority undergoing repair for insufficiency or stenosis.
- Infancy, prior hospitalization, and the presence of heart failure are significant risk factors for adverse outcomes, including early mortality.
- Strategies to mitigate risks in these high-risk pediatric populations are warranted to improve long-term results.
Objective:
To characterize national experience with surgical aortic valve repair in pediatric patients.
Methods:
Patients in the Pediatric Health Information System database aged 17 years or younger with International Statistical Classification of Diseases and Related Health Problems codes for open aortic valve repair from 2003 to 2022 were included (n = 5582). Outcomes of reintervention during index admission (repeat repair, n = 54; replacement, n = 48; and endovascular intervention, n = 1), readmission (n = 2176), and in-hospital mortality (n = 178) were compared. A logistic regression was performed for in-hospital mortality.
Results:
One-quarter (26%) of patients were infants. The majority (61%) were boys. Heart failure was present in 16% of patients, congenital heart disease in 73%, and rheumatic disease in 4%. Valve disease was insufficiency in 22% of patients, stenosis in 29%, and mixed in 15%. The highest quartile of centers by volume (median, 101 cases; interquartile range, 55-155 cases) performed half (n = 2768) of cases. Infants had the highest prevalence of reintervention (3%; P < .001), readmission (53%; P < .001), and in-hospital mortality (10%; P < .001). Previously hospitalized patients (median, 6 days; interquartile range, 4-13 days) were at higher risk for reintervention (4%; P < .001), readmission (55%; P < .001), and in-hospital mortality (11%; P < .001), as were patients with heart failure (reintervention [6%; P < .001], readmission [42%; P = .050], and in-hospital mortality [10%; P < .001]). Stenosis was associated with reduced reintervention (1%; P < .001) and readmission (35%; P = .002). The median number of readmissions was 1 (range, 0-6) and time to readmission was 28 days (interquartile range, 7-125 days). A regression of in-hospital mortality identified heart failure (odds ratio, 3.05; 95% CI, 1.59-5.49), inpatient status (odds ratio, 2.40; 95% CI, 1.19-4.82), and infancy (odds ratio, 5.70; 95% CI, 2.60-12.46) as significant.
Conclusions:
The Pediatric Health Information System cohort demonstrated success with aortic valve repair; however, early mortality remains high in infants, hospitalized patients, and patients with heart failure.
