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A Comparison for Infantile Mortality of Crucial Congenital Heart Defects in Korea over a Five-Year Period
Keesoo Ha1, Chanmi Park2, Junghwa Lee1
1Department of Pediatrics, College of Medicine, Korea University, Seoul 02841, Republic of Korea.
Insights
Infant mortality from congenital heart defects (CHDs) remains high. While outcomes for Tetralogy of Fallot (TOF) and Total Anomalous Pulmonary Venous Return (TAPVR) are improving, palliative procedures for Hypoplastic Left Heart Syndrome (HLHS) need enhancement.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Epidemiology
- Infant Health Outcomes
Background:
- Congenital heart defects (CHDs) contribute significantly to infant mortality, despite treatment advancements.
- Understanding epidemiology of high-mortality CHDs in infancy is crucial for improving survival rates.
- This study focuses on Korean infants, examining critical CHDs and their associated mortality.
Purpose of the Study:
- To comprehensively analyze overall and surgical mortality rates in infants with critical CHDs.
- To identify specific CHDs with the highest mortality risks during infancy.
- To provide insights for improving CHD management and outcomes in the pediatric population.
Main Methods:
- Analysis of a large dataset of 1,964,691 infants born in Korea between 2014 and 2018.
- Inclusion criteria focused on crucial CHDs, excluding simple shunt defects.
- Evaluation of overall mortality (natural and procedural) and procedural mortality (surgical and interventional).
Main Results:
- 16% of infants with crucial CHDs underwent multiple procedures.
- Overall and surgical mortality rates for crucial CHDs were 8% and 7%, respectively.
- Mortality rates for palliative procedures were notably high, with significant decreases in procedural mortality for Tetralogy of Fallot (TOF), atrioventricular septal defects, and Total Anomalous Pulmonary Venous Return (TAPVR).
- Surgical mortality for TOF and TAPVR infants was lower, but higher for Hypoplastic Left Heart Syndrome (HLHS) infants compared to all ages.
Conclusions:
- Improvement in palliative procedural techniques is essential for better infant outcomes, especially for HLHS palliative surgery.
- Excellent infantile procedural outcomes for TOF and TAPVR are vital for overcoming critical early-life challenges.
- This study establishes a foundation for understanding CHD epidemiology in Korean infants, highlighting areas for targeted intervention.
Abstract:
Background: Nearly half of congenital heart defects (CHDs) related to mortality occur during infancy although advancements in treatments have increased the survival rates. This study comprehensively examined overall and surgical mortality in CHD infants with the highest mortality rates in an effort to improve our understanding of CHD epidemiology. Methods: Participants were drawn from a dataset of 1,964,691 infants born between 2014 and 2018 in Korea. Crucial CHDs are defined here as including diverse categorical defects and classical critical CHDs but excluding simple shunt defects. Overall mortality (procedural and natural mortality) and procedural mortality (interventional and surgical mortality) for infants were analyzed. Results: The performance rate for multiple procedures in infants with crucial CHDs was 16%. The overall and surgical mortalities of crucial CHDs were 8% and 7%. The mortalities of palliative procedures were relatively high. Procedural mortalities for infants were significantly decreased in the tetralogy of Fallot (TOF), atrioventricular septal defects, and total anomalous pulmonary venous return (TAPVR) compared with overall mortalities for infants. Surgical mortalities for infants involving TOF and TAPVR were significantly lower, but those for infants involving hypoplastic left heart syndrome (HLHS) were higher than those for all ages. Conclusions: Palliative procedural techniques in infants must be improved to obtain better outcomes, particularly in the palliative surgery of HLHS. The infantile procedural outcomes for TOF and TAPVR are excellent and important in order to overcome disastrous circumstances during infancy. This comprehensive study of the overall and procedural mortalities of CHDs may have laid a cornerstone for CHD epidemiology in Korean infants.
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