Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index

Abstract

Background Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery. Methods and Results This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58); P =0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9). Conclusions Survivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes.

The effect of maternal pre-/early-pregnancy BMI and pregnancy smoking and alcohol on congenital heart diseases: a parental negative control study

“…In confounder and other parent BMI adjusted analyses, there was no difference in the odds of offspring CHD per 1kg/m 2 difference in maternal BMI (OR: 1.00, 95%CI: 0.99, 1.02) or paternal mean BMI (OR: 1.01, 95%CI: 0.99, 1.03) (P diff = 0.43), with both being close to the null ( Figure 1A ). Results were similar across studies (I 2 = 0% & 0%, P heterogeneity = 0.45 & 0.68 for maternal and paternal BMI respectively). Unadjusted and confounder only adjusted results did not differ notably from those presented in Figure 1 (Figure S8).…”

“…In confounder and other parental smoking adjusted analyses any maternal smoking in pregnancy was associated with increased odds of CHD (OR: 1.11, 95%CI: 0.97, 1.25), whereas paternal smoking at the time of their partners pregnancy did not increase odds of offspring CHD (OR: 0.96, 95%CI: 0.85, 1.07) (P diff = 0.09) ( Figure 2A ). There was no statistical evidence of heterogeneity across studies for maternal or paternal estimates (I 2 = 0% & 0%, P heterogeneity = 0.82 & 0.65 for maternal and paternal smoking, respectively). Results for unadjusted analyses were consistent with the confounder and mutual parent smoking adjusted result, whereas confounder only analyses were slightly attenuated for maternal smoking (Figure S17).…”

“…Because of very small numbers of underweight parents, particularly fathers, however, results were imprecise with wide confidence intervals and there was no statistical evidence for between parental differences for underweight (P diff underweight = 0.27). Individual study results for BMI categories are shown in Figures S11-S13; there was no statistical evidence of heterogeneity across studies in the results shown in Figure 1B (I 2 = 0%, Figure S13).…”

“…All the data used in the present study originated from European birth cohorts, with broadly similar methods and therefore, we assumed that they were each estimating an association from the same underlying populations and used a fixed-effects meta-analysis. To explore this assumption, differences between studies were assessed using I 2 and Cochrane Q P-values for heterogeneity 37 .…”

Prevalence of Complications Following Unifocalization and Pulmonary Artery Reconstruction Procedures

“…[2][3][4] The reliability of the modern CPB circuits has resulted in an important paradigm shift from speed to precision. [5][6][7][8][9] This has also permitted an expansion in the complexity of cases that can be undertaken given the safety of the CPB circuits.…”