Outcomes of neonates requiring prolonged stay in the intensive care unit after surgical repair of congenital heart disease

Mori, Makoto; Maher, Kevin; Kogon, Brian; Mahle, William T.; Kanter, Kirk R.; Alsoufi, Bahaaldin

doi:10.1016/j.jtcvs.2016.04.040

Cited by 19 publications

(18 citation statements)

References 23 publications

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“…The median age for patients requiring ECMO in our study was 0.5 years, with younger patients being more likely to require ECMO. This finding is consistent with other studies that have also demonstrated a greater need for ECMO in neonates and infants [ 9 , 12 , 13 ]. In patients receiving ECMO, the length of admission was nearly triple that for those who did not receive ECMO, a finding consistent with previous studies that have demonstrated that ECMO increases ICU and overall admission durations [ 12 , 14 , 15 ].…”

Section: Discussionsupporting

confidence: 93%

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery

Aiello

Loomba

2017

Children

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Introduction: This study aimed to determine factors associated with the need for extracorporeal membrane oxygenation (ECMO) in children with congenital heart disease (CHD) during admission for cardiac surgery (CS). A secondary aim was to determine how ECMO impacted length, cost, and mortality of the admission. Methods: Data from the Kids’ Inpatient Database (KIDS) were utilized. Admissions with CHD under 18 years of age with cardiac surgery were included. Need for ECMO in these admissions was then identified. Univariate analysis was conducted to compare characteristics between admissions with and without ECMO. Regression analyses were conducted to determine what factors were independently associated with ECMO and whether ECMO independently impacted admission characteristics. Results: A total of 46,176 admissions with CHD and CS were included in the final analysis. Of these, 798 (1.7%) required ECMO. Median age of ECMO admissions was 0.5 years. The following were associated with ECMO: decreased age, heart failure, acute kidney injury, arrhythmia, double outlet right ventricle, atrioventricular septal defect, transposition, Ebstein anomaly, hypoplastic left heart syndrome, common arterial trunk, tetralogy of Fallot, coronary anomaly, valvuloplasty, repair of total anomalous pulmonary venous connection, arterial switch, RV to PA conduit placement, and heart transplant (p < 0.01). ECMO independently increased length of stay by 17.8 days, cost of stay by approximately $415,917, and inpatient mortality 22-fold. Conclusion: Only a small proportion of CHD patients undergoing CS require ECMO, although these patients require increased resource utilization and have high mortality. Specific cardiac lesions, cardiac surgeries, and comorbidities are associated with increased need for ECMO.

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Section: Discussionsupporting

confidence: 93%

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery

Aiello

Loomba

2017

Children

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“…Accordingly, there were less postoperative complications and less degree of postoperative AVV regurgitation in patients who received AVV surgery before TCPC. Because previous studies demonstrated prolonged stay is associated with postdischarge morbidities, 14,35 performing TCPC as a sole therapy seems to be important, and our results supported the rationale for early AVV repair before TCPC. Our institutional policy to address moderate AVV regurgitation has gradually been changed to perform AVV repair as a sole operation before TCPC.…”

Section: Timing Of Atrioventricular Valve Surgery: Before or At The Tsupporting

confidence: 79%

Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: Impact of valve morphology and underlying mechanisms on survival and reintervention

Ono

Cleuziou

Ohain

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Atrioventricular valve regurgitation in univentricular heart is more frequently associated with a tricuspid or a common atrioventricular valve, and structural anomalies are the primary cause. Significant atrioventricular valve regurgitation requiring surgery influences survival after total cavopulmonary connection, especially when atrioventricular valve replacement was needed. Surgical management based on mechanisms of regurgitation is mandatory.

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“…Mori and colleagues' analysis of the association of intensive care unit (ICU) length of stay and outcomes in neonates after congenital heart surgery, 1 on the surface at least, seems to state the obvious: if a newborn is in the ICU for an extended period, they are a member of a subgroup of patients who are at increased risk of mortality. It is tempting to set the authors' research aside with that observation, concluding there is little to be learned here.…”

Section: Editorial Commentarymentioning

confidence: 99%

Neonatal outcomes and length of stay: A firm grasp of the obvious?

Overman

2016

The Journal of Thoracic and Cardiovascular Surgery

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Outcomes of neonates requiring prolonged stay in the intensive care unit after surgical repair of congenital heart disease

Cited by 19 publications

References 23 publications

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery

Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: Impact of valve morphology and underlying mechanisms on survival and reintervention

Neonatal outcomes and length of stay: A firm grasp of the obvious?

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