INTRODUCTION:Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score is a simple
model that can be easily applied and has been widely used for mortality
comparison among pediatric cardiovascular services. It is based on the
categorization of several surgical palliative or corrective procedures,
which have similar mortality in the treatment of congenital heart
disease.OBJECTIVE:To analyze the in-hospital mortality in pediatric patients (<18 years)
submitted to cardiac surgery for congenital heart disease based on RACHS-1
score, during a 12-year period.METHODS:A retrospective date analysis was performed from January 2003 to December
2014. The survey was divided in two periods of six years long each, to check
for any improvement in the results. We evaluated the numbers of procedures
performed, complexity of surgery and hospital mortality.RESULTS:Three thousand and two hundred and one surgeries were performed. Of these,
3071 were able to be classified according to the score RACHS-1. Among the
patients, 51.7% were male and 47.5% were younger than one year of age. The
most common RACHS-1 category was 3 (35.5%). The mortality was 1.8%, 5.5%,
14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There
was a significant increase in the number of surgeries (48%) and a
significant reduction in the mortality in the last period analysed (13.3% in
period I and 10.4% in period II; P=0.014).CONCLUSION:RACHS-1 score was a useful score for mortality risk in our service, although
we are aware that other factors have an impact on the total mortality.
IPT in newborns is usually associated with a good prognosis without the need for intrauterine procedures. Cases with IPT-related death are associated with hemodynamic impairment in fetuses with hydrops.
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