Regionalization of Brazilian pediatric cardiovascular surgery

Júnior, Valdester Cavalcante Pinto; Fraga, Maria de Nazaré de Oliveira; Freitas, S. P.; Croti, Ulisses Alexandre

doi:10.5935/1678-9741.20130036

Cited by 5 publications

(6 citation statements)

References 7 publications

(2 reference statements)

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“…About 90% of births worldwide occur in these countries and only a small portion of the population (7%) have access to treatment of congenital heart disease, by lack of resources in the area, leading to increases in morbidity and mortality [ 18 ] . This study was performed in a state in Northeastern Brazil, characterized by presenting various social, infrastructure and funding issues [ 19 , 20 ] . Due to late diagnosis and poor access to specialized tertiary center, patients are lately referred for surgery.…”

Section: Discussionmentioning

confidence: 99%

Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center

Cavalcante¹,

Souza²,

Júnior³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center

Cavalcante¹,

Souza²,

Júnior³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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“…Pinto Jr et al [ 22 ] propose, in a study on regionalization of Brazilian pediatric cardiovascular surgery, the implementation of a support network for patients with congenital heart disease, of fair range for all regions of Brazil. Therefore, it becomes important to define the prevalence and distribution of the disease and its subtypes for each territory.…”

Section: Discussionmentioning

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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“…Congenital heart disease (CHD) remains a major healthcare issue, and mitigating CHD mortality in developing countries could have a significant impact on the elevated childhood mortality rates [ 1 - 3 ] . As the vast majority of CHD require surgical treatment, improvement in surgical outcomes is highly desirable.…”

Section: Introductionmentioning

confidence: 99%

Translation and Validation of the Boston Technical Performance Score in a Developing Country

Miana¹,

Nathan²,

Tenório³

et al. 2021

Braz J Cardiovasc Surg

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Introduction The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P =0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P =0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P =0.004). Conclusion TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.

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Regionalization of Brazilian pediatric cardiovascular surgery

Abstract: 256Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg

Cited by 5 publications

References 7 publications

Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center

Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center

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

Translation and Validation of the Boston Technical Performance Score in a Developing Country

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