The amount of cardiovascular support in the first 48 hrs after congenital heart surgery with cardiopulmonary bypass predicts eventual morbidity and mortality in young infants. The degree of support is best characterized by a maximum vasoactive-inotropic score obtained during this period. The usefulness of vasoactive-inotropic score as an independent predictor of clinical outcome in infants after cardiac surgery may have important implications for future cardiothoracic intensive care unit research.

Requirement for tracheostomy in pediatric patients after cardiac surgery was associated with significant mortality. Patients with single ventricle have the highest late death rate and those with chronic ventilator dependency were unlikely to undergo successful Fontan completion.

Complete repair of TOF in the neonate is associated with excellent intermediate-term survival. Although the reoperation rate is significant, this is to be expected with the complex right ventricular outflow tract and pulmonary artery anatomy seen in symptomatic neonates and the need for conduit replacement in patients with TOF with pulmonary atresia.

Objectives We sought to identify factors associated with death and cardiac transplantation in infants undergoing the Norwood procedure and to determine differences in associations that might favor either the modified Blalock-Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). Methods We used competing risks methodology to analyze death without transplantation, cardiac transplantation, and survival without transplantation. Parametric time-to-event modeling and bootstrapping were used to identify independent predictors. Results Data from 549 subjects (follow-up, 2.7±0.9 years) were analyzed. Mortality risk was characterized by early and constant phases; transplant was characterized by only a constant phase. Early phase factors associated with death included lower socioeconomic status (SES; P=.01), obstructed pulmonary venous return (P<.001), smaller ascending aorta (P=.02), and anatomic subtype. Constant phase factors associated with death included genetic syndrome (P<.001) and lower gestational age (GA, P<.001). The RVPAS had better survival in the 51% who were full term with aortic atresia (P<.001). The MBTS was better among the 4% who were preterm with a patent aortic valve (P =.003). Lower pre-Norwood right ventricular fractional area change, pre-Norwood surgery, and anatomy other than hypoplastic left heart syndrome were independently associated with transplantation (all P<.03); but shunt type was not (P=.43). Conclusions Independent risk factors for intermediate-term mortality include lower SES, anatomy, genetic syndrome, and lower GA. Term infants with aortic atresia benefited from a RVPAS and preterm infants with a patent aortic valve benefited from a MBTS. Right ventricular function and anatomy, but not shunt type, were associated with transplantation.

Background Administrative datasets are often used to assess outcomes and quality in pediatric heart surgery; however their accuracy regarding case ascertainment is unclear. We linked patient data (2004–2010) from the STS Congenital Heart Surgery Database (clinical registry), and Pediatric Health Information Systems Database (administrative database) from hospitals participating in both to evaluate differential coding/classification of operations between datasets, and subsequent impact on outcomes assessment. Methods Eight individual benchmark operations and the RACHS-1 categories were evaluated. The primary outcome was in-hospital mortality. Results The cohort included 59,820 patients (33 centers). There was a >10% difference in the number of patients identified between datasources for half of the benchmark operations. Negative predictive value of the administrative (vs. clinical) data was high (98.8–99.9%); positive predictive value was lower (56.7–88.0%). Overall agreement between datasources in RACHS-1 category assignment was 68.4%. These differences translated into significant differences in outcomes assessment, ranging from an underestimation of mortality associated with truncus arteriosus repair by 25.7% in the administrative vs. clinical data (7.01% vs. 9.43%, p=0.001), to an overestimation of mortality associated with VSD repair by 31.0% (0.78% vs. 0.60%, p=0.1). For the RACHS-1 categories, these ranged from an underestimation of Category 5 mortality by 40.5%, to an overestimation of Category 2 mortality by 12.1%; these differences were not statistically significant. Conclusions This study demonstrates differences in case ascertainment between administrative and clinical registry data for children undergoing heart surgery, which translated into important differences in outcomes assessment.