Excellent Cardiac Surgical Outcomes in Paediatric Indigenous Patients, but Follow-up Difficulties

Rohde, Simon L.; Matebele, Mbakise; Pohlner, Peter; Radford, Dorothy J.; Wall, Douglas

doi:10.1016/j.hlc.2010.03.008

Cited by 10 publications

(10 citation statements)

References 16 publications

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“…The mortality rates of 3.3% observed here in the present study are comparable to those seen elsewhere with cardiac centres and other database that are reported to range from 1.8-6.1% [10][11][12][13] . Edwin et al reported mortality rates of 3% among patients with congenital heart disease undergoing open heart surgery, with a reduction in mortality with increase in the volumes of patients operated 8 .…”

Section: Discussionsupporting

confidence: 90%

“…However the patients operated at the UHI were significantly older, there were no neonatal surgeries, and involved significantly less complex congenital heart disease which could have contributed to lower rates of complications. Neonatal surgeries or surgeries for very complex congenital heart disease are associated with higher rates of postoperative morbidity and mortality [10][11]13 . The visiting teams also had cardiac intensivists that could have helped reduce the mortality in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

Aliku¹,

Lubega²,

Lwabi³

et al. 2015

Afr H. Sci.

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Background: Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). Objectives: We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country. Methods: Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed. Results: A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2 % Conclusion: Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

Aliku¹,

Lubega²,

Lwabi³

et al. 2015

Afr H. Sci.

View full text Add to dashboard Cite

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“…Other morbidities appeared to be similar to those reported by other authors [1, 2, 6, 26]. For a meaningful clinical correlation, we explored cases where the patient developed fever within 10 days after the operation.…”

Section: Discussionmentioning

confidence: 66%

Surveillance of Pediatric Cardiac Surgical Outcome Using Risk Stratifications at a Tertiary Care Center in Thailand

Vijarnsorn

Laohaprasitiporn²,

Durongpisitkul³

et al. 2011

Cardiology Research and Practice

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Objectives. To determine in-hospital mortality and complications of cardiac surgery in pediatric patients and identify predictors of hospital mortality. Methods. Records of pediatric patients who had undergone cardiac surgery in 2005 were reviewed retrospectively. The risk adjustment for congenital heart surgery (RACHS-1) method, the Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery Mortality score (STS-EACTS score) were used as measures. Potential predictors were analyzed by risk analysis. Results. 230 pediatric patients had undergone congenital cardiac surgery. Overall, the mortality discharge was 6.1%. From the ROC curve of the RACHS-1, the ABC level, and the STS-EACTS categories, the validities were determined to be 0.78, 0.74, and 0.67, respectively. Mortality risks were found at the high complexity levels of the three tools, bypass time >85 min, and cross clamp time >60 min. Common morbidities were postoperative pyrexia, bleeding, and pleural effusion. Conclusions. Overall mortality and morbidities were 6.1%. The RACHS-1 method, ABC score, and STS-EACTS score were helpful for risk stratification.

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“…In our series, the overall mortality was 10.7% in all 616 patients. In the other congenital heart surgery centers, the in‐hospital mortality rates for pediatric cardiac surgery decreased significantly from 8.7–22% to 4.6–6% in the past two decades . Recently, a report on indigenous Australian pediatric patients who had undergone congenital cardiac surgery showed overall complication rates of 20–32% and a mortality rate of 1.82% .…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Patients in a Start‐Up Congenital Heart Surgery Program in Turkey

et al. 2013

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This study summarizes the clinical outcome data of a start-up congenital heart surgery program in Turkey. Between December 2009 and February 2012, 616 operations have been performed in 132 newborns (22%), 260 infants (42%), and 224 children/adolescents (36%). Risk adjustment analysis was performed using the risk adjustment in congenital heart surgery (RACHS-1) risk assessment model. There were 66 mortalities (10.7%). According to the RACHS-1 categories, there were 51 cases in level I (8.2%) with no mortality (0%), 250 in level II (40.6%) with 11 (4.4%) mortalities, 199 in level III (32.3%) with 33 (16.5%) mortalities, 53 in level IV (8.6%) with 10 (18.8%) mortalities, 14 in level V and VI (2.2%) with 11 (78.5%) mortalities, and 49 cases (7.9%) out of the RACHS-1 categories with one (2.0%) mortality. Mortality was higher in neonates compared to infants, and in infants compared to children/adolescents. Mortality was higher in palliative procedures compared to corrective procedures. The data demonstrate that a start-up program with a relatively loaded surgical volume may achieve acceptable clinical results with a good teamwork. Collaboration of anesthesiologists, perfusionists, pediatric cardiologists, intensivists, and cardiovascular surgeons is necessary to provide a better outcome in congenital heart surgery.

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Excellent Cardiac Surgical Outcomes in Paediatric Indigenous Patients, but Follow-up Difficulties

Cited by 10 publications

References 16 publications

Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

Surveillance of Pediatric Cardiac Surgical Outcome Using Risk Stratifications at a Tertiary Care Center in Thailand

Clinical Outcome of Patients in a Start‐Up Congenital Heart Surgery Program in Turkey

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