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.
Insights
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.
Background:
Atrial septal defects (ASDs) are a common cause of congenital heart disease worldwide.
Objectives:
The purpose of the study was to assess change over time in surgical outcomes for ASD repair and identify patient-level risk factors for adverse postoperative outcomes.
Methods:
We analyzed cases of isolated ASD in patients <18 years from 2010 to 2020 from 71 sites participating in the International Quality Improvement Collaborative for Congenital Heart Disease. Regression models identified associations between patient characteristics and 3 outcome variables: in-hospital death, major infection, and intensive care unit (ICU) length of stay (LOS).
Results:
Among 9,127 ASD closures, 7,653 (84%) were ASD secundum. A total of 914 patients (10%) had ASD repair at <1 year. A total of 3,363 (38%) were <5% for World Health Organization weight/body mass index for age percentile. A total of 2,511 surgeries (28%) occurred from 2010 to 2014 and 6,616 (72%) from 2015 to 2020. Overall, in-hospital mortality was 0.45% and major infection was 0.65%. Median ICU LOS was 27 hours. Prematurity (odds ratio [OR]: 9.62; P = 0.006), oxygen saturation <90% (OR: 5.89; P = 0.004), and year of surgery 2010 to 2014 (OR: 5.18; P < 0.001) were associated with in-hospital mortality. Age <1 year (OR: 2.24; P = 0.008), noncardiac anomaly (OR: 4.67; P < 0.001), chromosomal abnormality (OR: 2.54; P = 0.029), preoperative intervention (OR: 4.67; P = 0.008), low World Health Organization weight/body mass index for age <5% (OR: 2.36; P = 0.019), and year of surgery 2010 to 2014 (OR: 2.40; P = 0.011) were associated with infection. ICU LOS did not change between the 2 time periods, adjusting for other factors.
Conclusions:
High-quality surgical programs in low- and middle-income countries experienced an over 5-fold reduction in in-hospital mortality and an over 2-fold reduction of infection after ASD surgery over the past decade, with rates now comparable to some high-income settings, supporting equitable access to life-saving surgery.
