Outcome of pediatric cardiac surgery and predictors of major complication in a developing country

Murni, Indah Kartika; Djer, Mulyadi M.; Yanuarso, Piprim B.; Putra, Sukman Tulus; Advani, Najib; Rachmat, Jusuf; Perdana, Aries; Sukardi, Rubiana

doi:10.4103/apc.apc_146_17

Cited by 40 publications

(53 citation statements)

References 24 publications

(28 reference statements)

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“…In this issue of Annals, Murni et al . present an article titled, “Outcomes of pediatric cardiac surgery and predictors of major complications in a developing country.”[1] The study analyzes the outcomes of pediatric cardiac surgeries performed at the Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia, over a period of 1 year. They report a 13.6% 30-day mortality and a 19% incidence of major complications in a cohort of patients that were predominantly (95%) in RACHS Category 1 or 2.…”

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confidence: 99%

Pediatric cardiac surgery in low- and middle-income countries – Fighting the odds

Iyer

2019

Ann Pediatr Card

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Pediatric cardiac surgery in low- and middle-income countries – Fighting the odds

Iyer

2019

Ann Pediatr Card

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“…In another study from a private tertiary care institute in Pakistan, the mortality rate reported in pediatric cardiac surgeries was 6-8.7% [13]. Studies from other low- and middle-income countries have also reported higher mortality among children after cardiac surgery: Indonesia - 12.8% [14]; Iran - 12.4% [15]; Guatemala - 10.7% [16]; and India - 11.5% [17]. Contrary to this, high-income countries have reported less than 5% mortality after pediatric cardiac surgery [18].…”

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confidence: 99%

The Spectrum of Pediatric Cardiac Procedures and Their Outcomes: A six-month Report from the Largest Cardiac Facility in Sindh, Pakistan

Khokhar

Gowa

Bangash

et al. 2019

Cureus

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IntroductionCongenital heart disease (CHD) is the most common birth defect globally, with low-to-middle income Asian countries registering the highest incidence. Every year, 60,000 babies are born with varying severity of CHD in Pakistan. But the country has only three pediatric intensive care units (PICU) fully dedicated to child cardiac surgery patients. The focus of this study is to analyze the spectrum of pediatric cardiac surgical procedures performed for the management of CHD and their outcomes in a cardiac PICU in Pakistan.MethodsIn this analysis, all surgical records of children admitted to the PICU of National Institute of Cardiovascular Diseases (NICVD), Karachi, from October 2018 to March 2019 were included. It is a 14-bed, state-of-the-art cardiac PICU, which provides high-quality care to critical post-surgical patients.ResultsThe surgical records of 537 patients were extracted for the purpose of our study, which accounted for 89.5 of post-operative patients admitted in the PICU per month and three per day. Tetralogy of Fallot (TOF) was the most commonly treated anomaly (n = 161; 29.9%) in the facility, followed by ventricular septal defect (n = 107; 19.9%). The overall mortality rate was 5.4% (n = 29), out of which 27.5% (n = 8) were TOF-related.ConclusionsThere is a very high burden of patients on the cardiac PICUs in low-to-middle income Asian countries. Despite the lack of resources, the high- quality care provided by pediatric cardiac critical-care specialists at these PICUs has ensured favorable outcomes and a mortality rate as low as that in any of the developed countries.

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“…A greater number of categories in the RACHS-1 represents progressively more difficult surgical cases. RACHS-1 classification uses surgical procedures to predict the risk associated with the operation and the measure has been used in the context of developing countries [26][27][28]. Two cardiac surgeons independently coded the procedures using the RACHS-1 classification and agreed on the final assignment.…”

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Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications

Choi

Heo

et al. 2020

Annals of Global Health

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Background: Most children who have congenital heart disease in low-and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019. Objectives: To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients' pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs. Methods: To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients' pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17). Findings: During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery. Conclusions: Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.

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Outcome of pediatric cardiac surgery and predictors of major complication in a developing country

Cited by 40 publications

References 24 publications

Pediatric cardiac surgery in low- and middle-income countries – Fighting the odds

Pediatric cardiac surgery in low- and middle-income countries – Fighting the odds

The Spectrum of Pediatric Cardiac Procedures and Their Outcomes: A six-month Report from the Largest Cardiac Facility in Sindh, Pakistan

Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications

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