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Multiple system organ failure after open heart surgery in infants and children
M C Seghaye1, W Engelhardt, R G Grabitz
1Department of Pediatric Cardiology, RWTH Aachen, Germany.
Insights
Multiple system organ failure (MSOF) occurred in 3.5% of pediatric patients after congenital heart disease surgery. This condition, marked by organ dysfunction and fever, led to significant mortality and long-term neurological issues in survivors.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Congenital Heart Disease
Background:
- Congenital heart disease necessitates complex surgical interventions, often involving cardiopulmonary bypass.
- Postoperative complications, such as multiple system organ failure (MSOF), pose significant risks in pediatric cardiac surgery.
- Understanding the incidence and outcomes of MSOF is crucial for improving patient management.
Purpose of the Study:
- To determine the incidence of multiple system organ failure (MSOF) in children undergoing cardiac surgery for congenital heart disease.
- To describe the clinical characteristics and early outcomes of MSOF in this pediatric population.
- To evaluate the mortality and morbidity associated with MSOF post-cardiac surgery.
Main Methods:
- Retrospective observational study of 460 children who underwent cardiac surgery with cardiopulmonary bypass between January 1985 and March 1989.
- Defined MSOF as failure of two or more vital organ systems within the first postoperative week, accompanied by fever, thrombocytopenia, and cardiocirculatory insufficiency.
- Analyzed clinical manifestations, organ system involvement, and patient outcomes, including mortality and long-term sequelae.
Main Results:
- The incidence of MSOF was 3.5% (16 out of 460 children).
- All affected children presented with acute renal and hepatic failure, high fever, and thrombocytopenia; most also had respiratory and neurological involvement.
- Mortality rate was 43.75% (7 out of 16 children), and 44% of survivors experienced persistent neurological sequelae at 6 months.
Conclusions:
- Multiple system organ failure is a serious complication following pediatric cardiac surgery for congenital heart disease, associated with high mortality.
- Early recognition and management of MSOF are critical, given its rapid onset and severe consequences.
- Neurological sequelae are a significant concern for survivors, highlighting the need for comprehensive postoperative care and follow-up.
Abstract:
Between January 1985 and March 1989 we retrospectively observed multiple system organ failure (MSOF) in 16 of 460 children (3.5%) who underwent cardiac surgery with cardiopulmonary bypass for congenital heart disease. MSOF was arbitrarily defined as a clinical entity with failure of two or more vital organ systems associated with high fever, thrombocytopenia, and cardiocirculatory insufficiency and occurring within the first postoperative week. In 13 children the first clinical manifestations of MSOF were evident on the first post-operative day and in the other 3 on the second or third post-operative day. All children showed acute renal failure, acute hepatic failure, high fever, and thrombocytopenia. Most of them showed respiratory insufficiency and neurological involvement. Seven of the 16 children died. Four of the 9 surviving patients had neurological sequelae still present 6 months after the operation, and the others recovered completely.