Associations With Adverse Postoperative Outcomes in Children Undergoing Atrial Septal Defect Closure in
Rachel E Wittenberg1,2, Kimberlee Gauvreau2, María Belén Desocio3
1Harvard Medical School, Boston, Massachusetts, USA.
JACC. Advances
|January 16, 2025
Summary
Surgical outcomes for atrial septal defect (ASD) repair have improved significantly, with reduced mortality and infection rates in pediatric patients. This progress supports better access to life-saving congenital heart defect surgery globally.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Public Health
Background:
- Atrial septal defects (ASDs) represent a significant global burden of congenital heart disease.
- Understanding trends in ASD repair outcomes is crucial for improving pediatric cardiac care.
Purpose of the Study:
- To evaluate changes in surgical outcomes for atrial septal defect (ASD) repair over time.
- To identify patient-specific risk factors associated with adverse postoperative outcomes in pediatric ASD cases.
Main Methods:
- Analysis of isolated ASD repair cases in patients under 18 years old from 2010-2020 across 71 international sites.
- Utilized regression models to associate patient characteristics with in-hospital mortality, major infection, and ICU length of stay (LOS).
Main Results:
- Over 9,000 ASD closures were analyzed; 84% were ASD secundum.
- In-hospital mortality was 0.45% and major infection was 0.65%, with a median ICU LOS of 27 hours.
- Prematurity, low oxygen saturation, and earlier surgical years (2010-2014) were linked to higher mortality; younger age, noncardiac anomalies, and low BMI were linked to infection.
Conclusions:
- High-quality surgical programs, particularly in lower-income countries, demonstrated over a 5-fold reduction in mortality and a 2-fold reduction in infection rates for ASD surgery.
- These improvements suggest more equitable access to essential pediatric cardiac surgery worldwide.
