Mortality rates after surgery for congenital heart defects in children and surgeons' performance

Stark, Jaroslav; Gallivan, S; Lovegrove, J. U.; Hamilton, J. R. L.; Monro, James L.; Pollock, James K.; Watterson, Kevin G.

doi:10.1016/s0140-6736(00)90001-1

Cited by 112 publications

(85 citation statements)

References 11 publications

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“…19,21 As has been observed, the groups (with and without music therapy) were homogenous at the start of the procedure in terms of the variables studied, confirming the random nature of the groups.…”

Section: Discussionsupporting

confidence: 63%

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Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Hatem¹,

Lira²,

Mattos³

2006

J. Pediatr. (Rio J.)

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Objective: To investigate, both objectively and subjectively, the effect of music on children in a pediatric cardiac intensive care unit following heart surgery, in conjunction with standard care.Methods: Randomized clinical trial with placebo, assessing 84 children, aged 1 day to 16 years, during the first 24 hours of the postoperative period, given a 30 minute music therapy session with classical music and observed at the start and end of the session, recording heart rate, blood pressure, mean blood pressure, respiratory rate, temperature and oxygen saturation, plus a facial pain score. Statistical significance was set at 5%.Results: Five of the initial 84 patients (5.9%) refused to participate. The most common type of heart disease was acyanotic congenital with left-right shunt (41% of cases: 44.4% of controls). Statistically significant differences were observed between the two groups after the intervention in the subjective facial pain scale and the objective parameters heart rate and respiratory rate (p < 0.001, p = 0.04 and p = 0.02, respectively).Conclusions: A beneficial effect from music was observed with children during the postoperative period of heart surgery, by means of certain vital signs (heart rate and respiratory rate) and in reduced pain (facial pain scale). Nevertheless, there are gaps to be filled in this area, and studies in greater depth are needed.

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Section: Discussionsupporting

confidence: 63%

“…19,20 Also of note is group 5 (22.8%), complex heart disease, a pattern that is common at referral centers for pediatric heart surgery, as is the case at the study center. [19][20][21] The Jenkins et al classification has shown itself highly suitable for classifying surgery in a scale of ascending severity. It was introduced in 1995.…”

Section: Discussionmentioning

confidence: 99%

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Hatem¹,

Lira²,

Mattos³

2006

J. Pediatr. (Rio J.)

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“…[1][2][3][4][5] The identification of ACHD patients at a heightened risk for such poor outcomes is of clinical relevance because it facilitates refinements in treatment that may ultimately improve individual patient outlook. Many of these patients are also limited in their everyday activities by debilitating symptoms such as exertional dyspnea.…”

mentioning

confidence: 99%

Abnormal Ventilatory Response to Exercise in Adults With Congenital Heart Disease Relates to Cyanosis and Predicts Survival

et al. 2006

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Background— Limited data exist with which to stratify risk in adult congenital heart disease (ACHD). An increased ventilatory response to exercise, expressed as ventilation per unit of carbon dioxide production (V̇ e /V̇ co 2 slope), is an established predictor of impaired survival in acquired heart disease. We sought to establish the distribution, relation to cyanosis, and prognostic value of the V̇ e /V̇ co 2 slope across a wide spectrum of ACHD patients. Methods and Results— Five hundred sixty ACHD patients of varying diagnoses and 50 healthy controls underwent cardiopulmonary exercise testing at a single laboratory between 2001 and 2004. Patient age was 33.2±12.9 years (mean±SD). Peak oxygen consumption was 23.5±9.0 mL · kg −1 · min −1 . V̇ e /V̇ co 2 slope for all patients was 36.3±15.3. The slope was raised in all ACHD groups compared with controls and was 73% higher in cyanotic patients. Cyanosis, with or without pulmonary arterial hypertension, was the strongest predictor of abnormal V̇ e /V̇ co 2 slope. The V̇ e /V̇ co 2 slope was the most powerful univariate predictor of mortality in the noncyanotic group and the only independent predictor of mortality among exercise parameters on multivariate analysis. In cyanotic patients, no parameter was predictive of death. Conclusions— Ventilatory response to exercise is abnormal across the spectrum of ACHD. Cyanosis is a powerful stimulus for such exaggerated ventilatory patterns irrespective of the presence of pulmonary arterial hypertension. Increased V̇ e /V̇ co 2 slope is the strongest exercise predictor of death in noncyanotic ACHD patients.

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“…However, for lesions such as tetralogy of Fallot, complete atrioventricular canal defect, and transposition of the great arteries without additional complicating defects or conditions, hospital mortality rates less than 5% are attainable. 19,[23][24][25] Patients who have more complex disease or who are more ill experience higher morbidity and mortality but have usually been best served in experienced surgical environments with consistent excellent outcomes among patients with more complicated illness. Furthermore, to offer patients a full range of surgical treatments, centers have offered pediatric cardiac transplant (as centers certified by the United Network for Organ Sharing) or have been closely affiliated with a certified transplant center.…”

Section: Cardiovascular Surgerymentioning

confidence: 99%

Guidelines for Pediatric Cardiovascular Centers

Cardiology¹

2002

Pediatrics

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ABSTRACT. Pediatric cardiovascular centers should aim to provide high-quality therapeutic outcomes for infants and children with congenital and acquired heart diseases. This policy statement describes critical elements and organizational features of centers in which high-quality outcomes have the greatest likelihood of occurring. Center elements include noninvasive diagnostic modalities, cardiac catheterization, cardiovascular surgery, and cardiovascular intensive care. These elements should be organizationally united in centers in which pediatric cardiac physician specialists and specialized pediatric staff work together to achieve and surpass existing quality-of-care benchmarks.

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Mortality rates after surgery for congenital heart defects in children and surgeons' performance

Cited by 112 publications

References 11 publications

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Abnormal Ventilatory Response to Exercise in Adults With Congenital Heart Disease Relates to Cyanosis and Predicts Survival

Guidelines for Pediatric Cardiovascular Centers

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