Unplanned reinterventions are associated with postoperative mortality in neonates with critical congenital heart disease

Abstract

Objective Neonates with critical congenital heart disease remain at risk of adverse outcomes after cardiac surgery. Residual or undiagnosed anatomic lesions might be contributory. The present study aimed to describe the incidence and type of cardiac lesions that lead to early, unplanned cardiac reintervention, identify the risk factors for unplanned reintervention, and explore the associations between unplanned reinterventions and hospital mortality. Methods The present single-center retrospective cohort study included 943 consecutive neonates with critical congenital heart disease who underwent cardiac surgery from 2002 to 2008. An unplanned cardiac reintervention was defined as a cardiac reoperation or interventional cardiac catheterization performed during the same hospitalization as the initial operation. Multivariate logistic regression analyses were used to identify the risk factors for unplanned cardiac reintervention and hospital mortality. Results Of the 943 neonates, 104 (11%) underwent an unplanned cardiac reintervention. The independent predictors of unplanned reintervention included prenatal diagnosis, lower birth weight, need for mechanical ventilation before the initial cardiac operation, lower attending surgeon experience, and greater Risk Adjustment in Congenital Heart Surgery, version 1, category. Those who underwent reintervention had increased hospital mortality (n = 33/104, 32%) relative to those who did not (n = 31/839, 4%; adjusted odds ratio, 8.6; 95% confidence interval, 4.7 to 15.6; P < .001). The mortality rates among patients undergoing surgical reintervention (23/66, 35%) or transcatheter reintervention (4/16, 25%), or both (6/22, 27%) were similar (P = .66). Conclusions The need for unplanned cardiac reintervention in neonates with critical congenital heart disease is strongly associated with increased mortality. Early unplanned reinterventions might be an important covariate in outcomes studies and useful as a quality improvement measure.

Impact of prenatal diagnosis of complex congenital heart disease on neonatal and infant morbidity and mortality

“…In addition, it helps the providers and the family to plan and coordinate an effective multidisciplinary care of these patients, well in advance of the delivery of the child . However, the benefits of prenatal diagnosis on morbidity and mortality in these infants are still a subject of debate . In this study, we found that prenatal diagnosis of complex CHD significantly improves the preoperative morbidity, more so with ductal‐dependent cardiac lesions (Table ).…”

“…Our results were similar to the findings in this study. In fact, some studies have even shown that prenatal diagnosis was associated with worse postoperative outcomes . The authors in those studies have hypothesized that postoperative outcomes are primarily influenced by the severity of the cardiac malformation.…”

“…Also, the enhanced survival benefits as shown in some studies have not been replicated in others. The survival benefits have also been shown to vary with the type of complex CHD . The primary objective of this retrospective study was to assess for any preoperative morbidity benefits associated with the prenatal diagnosis of complex CHD.…”

Transcatheter interventions across fresh suture lines in infants and children: An 8‐year experience

“…Important post‐surgical anastomotic narrowings, ranging from mild stenosis to outright complete obstruction, can result in hemodynamic instability in the early post‐operative period. In order to address such stenotic lesions, these patients often require an early reoperation, which can be associated with major risks including hemodynamic instability, delayed recovery, and even mortality . However, in many cases the stenotic lesions can be addressed safely in the catheterization laboratory.…”

Task Force 5: Pediatric Cardiology Fellowship Training in Critical Care Cardiology

“…Specifically, the trainee should be able to recognize patients who have a residual cardiac lesion, either due to an imperfect operation or incomplete preoperative diagnosis, and plan appropriate anatomic investigation and determine the need to recommend surgical or transcatheter intervention when clinically indicated. 3 In particular, the trainee should have sufficient training and experience to be effective in managing these types of patients:…”