Abstract:1 2The aim of our study was to investigate the incidence of congenital defects in children born in Croatia during a 3 period of 5 years, its association with extracardiac malformations, its treatment and outcome. Medical 4 information about the patients was obtained from 14 paediatric cardiology centres that cover the whole country.
Abstract:Objective: The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery-1 method were developed and used to compare outcomes of congenital heart surgery. We used both methods to compare results of procedures done on our patients in Croatian cardiosurgical centres and results of procedures done abroad.
Methods:The study population consisted of all patients with congenital heart disease born to Croatian residents between October 1, 2002 and October 1, 2007 undergoing a cardiovascular operation during that period. Results: Of the 556 operations, ABC score could be assigned to 553 and RACHS-1 score to 536 operations. Procedures were performed in 2 institutions in Croatia and 7 institutions abroad. The average complexity for cardiac procedures done in Croatia was significantly lower (p<0.001). With both systems, along with the increase in complexity, there is also an increase in mortality prior to discharge and postoperative length of stay. Only after adjustment for complexity are there marked differences in mortality and occurrence of postoperative complications.
Conclusion:Both ABC and RACHS-1 were predictive of in-hospital mortality as well as prolonged post-operative length to stay, and can be used as a tool in our country to evaluate a cardiosurgical model and recognise potential problems.
A neonate presented with signs of heart failure early after a Norwood procedure, due to increase of aortic and mitral valve regurgitation. Because repeated surgery was considered risky, we closed the aortic valve by catheter intervention with an Amplatzer Duct Occluder. Aortic regurgitation was abolished almost completely and the child improved. Unfortunately, 2 weeks after discharge, the patient died suddenly.
A 2-week-old male newborn with a double inlet left ventricle developed a cardiac arrest following modified Blalock–Taussig anastomosis in pediatric intensive care unit. Probable causes of the arrest were hemodynamic instability and thrombosed shunt, which was later recanalized on extracorporeal membrane oxygenation therapy, which was successfully used with a pump flow lower than recommended in these patients—without the shunt clip, but without any complications.
The use of standardised risk scores allows selection of complex cardiac diseases, which may have very different outcomes in various centres. In our case, those with higher ABC scores were correctly identified and referred for treatment abroad. In this way, we allowed gradual progress of the cardiosurgical model in Croatia and maintained an enviably low mortality rate.
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