Association Between Prenatal Diagnosis and Age at Surgery for Noncritical and Critical Congenital Heart Defects

Abstract

BACKGROUND: The relationship between the prenatal diagnosis of congenital heart defects (CHDs) and age at CHD surgery is poorly understood, despite the known relationships between age at surgery and long-term outcomes. The objective of this study was to determine the associations between prenatal diagnosis of CHD and age at surgery, and whether these associations differ for critical and noncritical CHDs. METHODS: This is a cohort analysis of patients aged 0 to 9 years who received their initial cardiac surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago between 2015 and 2021 with prenatal diagnosis as the exposure variable. All data were obtained from the locally maintained Society of Thoracic Surgeons Congenital Heart Surgery Database at Lurie Children’s Hospital. We used multivariable fixed effects regression models to estimate the strength of the association of prenatal diagnosis with age at surgery among patients with critical (surgery ≤60 days) and noncritical (surgery >60 days) CHDs. RESULTS: Of 1131 individuals who met inclusion criteria, 532 (47%) had a prenatal diagnosis, 428 (38%) had critical CHDs, 533 (47%) were female, and the median age at surgery was 119 days (interquartile range, 11–309 days). After controlling for demographics, comorbidities, and surgical complexity, the mean age at surgery was significantly younger in those with prenatally versus postnatally diagnosed critical CHD (7.1 days sooner, P <0.001) and noncritical CHDs (atrial septal defects [12.4 months sooner, P =0.037], ventricular septal defects [6.0 months sooner, P <0.003], and noncritical coarctation of the aorta [1.8 months sooner, P =0.010]). CONCLUSIONS: Younger age at CHD surgery, which is associated with postsurgical neurodevelopmental and physical outcomes, is significantly associated with prenatal CHD diagnosis. This relationship was identified for both critical and noncritical CHDs.

Incidence of delayed psychomotor development in pediatric patients with congenital heart defects

“…Woo J.L. et al (30) demonstrated that prenatal diagnosis of CHD is associated with younger age at surgery, with consequences for long-term neurodevelopmental and physical outcomes. Prenatal diagnosis of patients with critical CHDs (hypoplastic left heart syndrome, D-transposition of the great arteries) allowed surgery to be performed one week earlier than for those diagnosed postnatally, and for patients with noncritical CHDs (noncritical coarctation of the aorta, VSD and ASD) the mean age at surgery was 2 to 15 months earlier than for children diagnosed postnatally.…”

Patient‐reported barriers to prenatal diagnosis of congenital heart defects: A mixed‐methods study

“…However, using a previous dataset of children who received surgery at Lurie Children's between 2015 and 2021, we found prenatal diagnosis rates to be nearly identical before and during the pandemifc. 53 Our analysis excluded individuals who terminated their pregnancies, who may have experienced different barriers than those who experienced a live birth. Finally, our results may not generalize to other geographic areas.…”

Planning Ahead: Can Diagnosing Congenital Heart Disease Earlier Improve Outcomes?

“…The study by Woo et al 3 aimed to establish whether prenatal diagnosis is definitively associated with surgery at an earlier age, both in critical and noncritical CHD lesions. The authors utilized advanced modeling techniques and analyzed clinically detailed data from the Society of Thoracic Surgeons Congenital Heart Surgery Database at Ann & Robert H. Lurie Children's Hospital of Chicago.…”