A reflection on the performance of pediatric cardiac surgery in the State of São Paulo

Canêo, Luiz Fernando; Jatene, Marcelo Biscegli; Yatsuda, Nelson; Gomes, Walter J.

doi:10.5935/1678-9741.20120076

Cited by 15 publications

(17 citation statements)

References 7 publications

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“…This in-hospital mortality rate is similar to the in-hospital mortality rate recorded in the best Brazilian high-volume centers [7]. Even in the richest Brazilian state, an estimated 40 % of neonates requiring a heart surgery may not reach a cardiac center [2]. Such situation may have led patients in poor conditions to undergo ASO, but this is only conjectural, because we have not looked up this information in our records.…”

Section: Discussionsupporting

confidence: 73%

Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center

et al. 2015

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The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of in-hospital mortality and further need of re-operation at a single-center institution. Between September 1995 and January 2014, 128 consecutive arterial switch operations were performed. Surgical mortality during this period was analyzed retrospectively, and a follow-up analysis of the survivors was conducted. Surgical era, cardiopulmonary bypass time (p = 0.001), and diagnosis category (p = 0.025) influenced in-hospital mortality. The estimated overall survival for the 91 hospital survivors was 96.8, 96.4, and 96.2 % at 5, 10, and 15 years, respectively. The median follow-up time was 67 months (range 0.71-222 months). Three patients (5 %) presented severe aortic regurgitation. Right ventricle outflow tract systolic gradient by echocardiography was above 60 mmHg in 2 %. Late re-interventions occurred in 12 (13 %) patients with mean time of 64 ± 34 months after the initial procedure. Actuarial freedom from re-interventions at 5, 10, and 15 years was 96.4, 69.7, and 61.9 %, respectively. Arterial switch operation remains the procedure of choice in patients with transposition of great arteries. It can be performed even in middle-volume institutions, leading to the same middle- and long-term outcomes of high-volume institutions. Early high mortality rate may occur due not only to learning curve, but also to cardiopulmonary bypass time and ventricular septal defect closure.

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Section: Discussionsupporting

confidence: 73%

Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center

et al. 2015

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“…Transposition of the gap between standards, Ordinances 1169/GM and 210/SAS-MS [ 28 , 29 ] and the assistance requires political will and planning aimed at improving access to pediatric cardiovascular surgery centers, financing of Cardiology and Cardiovascular Surgery Pediatric; database feeding; promote management for quality and establish continuing education programs [ 5 , 6 ] .…”

Section: Discussionmentioning

confidence: 99%

“…In 2007, in Brazil, 6% of deaths in children under one year of age were by CHD [ 5 ] . Among the congenital malformations, cardiovascular abnormalities are the most common cause of infant mortality, 40% under study in São Paulo/Brazil [ 6 ] and 26.6% and 48.1% in the US [ 7 , 8 ] . Delays in the development and cognitive deficits are associated with a congenital heart disease of 20% to 30% [ 9 - 11 ] .…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of congenital heart disease in Brazil Approximation of the official Brazilian data with the literature

Júnior

Branco

Cavalcante

et al. 2015

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionCongenital heart disease is an abnormality in the structure or cardiocirculatory function, occurring from birth, even if diagnosed later. It can result in intrauterine death in childhood or in adulthood. Accounted for 6% of infant deaths in Brazil in 2007.ObjectiveTo estimate underreporting in the prevalence of congenital heart disease in Brazil and its subtypes.MethodsThe calculations of prevalence were performed by applying coefficients, giving them function rates for calculations of health problems. The study makes an approach between the literature and the governmental registries. It was adopted an estimate of 9: 1000 births and prevalence rates for subtypes applied to births of 2010. Estimates of births with congenital heart disease were compared with the reports to the Ministry of Health and were studied by descriptive methods with the use of rates and coefficients represented in tables.ResultsThe incidence in Brazil is 25,757 new cases/year, distributed in: North 2,758; Northeast 7,570; Southeast 10,112; South 3,329; and Midwest 1,987. In 2010, were reported to System of Live Birth Information of Ministry of Health 1,377 cases of babies with congenital heart disease, representing 5.3% of the estimated for Brazil. In the same period, the most common subtypes were: ventricular septal defect (7,498); atrial septal defect (4,693); persistent ductus arteriosus (2,490); pulmonary stenosis (1,431); tetralogy of Fallot (973); coarctation of the aorta (973); transposition of the great arteries (887); and aortic stenosis 630. The prevalence of congenital heart disease, for the year of 2009, was 675,495 children and adolescents and 552,092 adults.ConclusionIn Brazil, there is underreporting in the prevalence of congenital heart disease, signaling the need for adjustments in the methodology of registration.

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“…In a study on the performance of pediatric heart surgery in the state of São Paulo, a mean hospital mortality rate of 14% was described, with 26.8% among neonates and 9.32% among children from 29 days to 1 year of age. ( 8 ) Factors related to the studied sample may have led to increased mortality, such as the considerable proportion of neonates (29.3%), along with factors not evaluated in this study, such as comorbidities, malnutrition and duration of extracorporeal circulation. ( 9 ) In addition to intrinsic factors, it is important to assess external factors that affect the quality of heart surgery services in Brazil, with emphasis on delayed diagnosis of these patients, difficulty accessing specialized centers and lack of investment and capacity building.…”

Section: Discussionmentioning

confidence: 91%

Assessment of PIM-2 performance among surgical patients with heart disease and correlation of results with RACHS-1

Rezende¹,

Ricachinevsky²,

Botta³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectiveTo assess the performance of the Pediatric Index of Mortality (PIM) 2 and the Risk Adjustment for Congenital Heart Surgery (RACHS) in the postoperative period of congenital heart disease patients.MethodsRetrospective cross-sectional study. Data were collected from patient records to generate the scores and predictions using recommended techniques, demographic data and outcomes. The Mann-Whitney test, Hosmer-Lemeshow test, standardized mortality rate, area under the receiver operating characteristic (ROC) curve, chi square test, Poisson regression with robust variance and Spearman's test were used for statistical analysis.ResultsA total of 263 patients were evaluated, and 72 died (27.4%). These patients presented significantly higher PIM-2 values than survivors (p < 0.001). In the RACHS-1 classification, mortality was progressively higher according to the complexity of the procedure, with a 3.24-fold increase in the comparison between groups 6 and 2. The area under the ROC curve for PIM-2 was 0.81 (95%CI 0.75 - 0.87), while for RACHS-1, it was 0.70 (95%CI 0.63 - 0.77). The RACHS presented better calibration power in the sample analyzed. A significantly positive correlation was found between the results of both scores (rs = 0.532; p < 0.001).ConclusionRACHS presented good calibration power, and RACHS-1 and PIM-2 demonstrated good performance with regard to their discriminating capacities between survivors and non-survivors. Moreover, a positive correlation was found between the results of the two risk scores.

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A reflection on the performance of pediatric cardiac surgery in the State of São Paulo

Cited by 15 publications

References 7 publications

Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center

Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center

Epidemiology of congenital heart disease in Brazil Approximation of the official Brazilian data with the literature

Assessment of PIM-2 performance among surgical patients with heart disease and correlation of results with RACHS-1

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