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Alternative strategies in newborns and infants with major co-morbidities to improve congenital heart surgery outcomes at an emerging programme*

Published online by Cambridge University Press:  02 June 2015

Jannika Dodge-Khatami ,
Ali Dodge-Khatami ,
Jarrod D. Knudson ,
Samantha R. Seals ,
Avichal Aggarwal ,
Mary B. Taylor  and
Jorge D. Salazar
Jannika Dodge-Khatami
Affiliation:
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
Ali Dodge-Khatami*
Affiliation:
Pediatric and Congenital Heart Surgery, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
Jarrod D. Knudson
Affiliation:
Pediatric and Fetal Cardiology, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America Division of Pediatric Critical Care, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
Samantha R. Seals
Affiliation:
Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
Avichal Aggarwal
Affiliation:
Pediatric and Fetal Cardiology, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
Mary B. Taylor
Affiliation:
Pediatric and Fetal Cardiology, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America Division of Pediatric Critical Care, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
Jorge D. Salazar
Affiliation:
Pediatric and Congenital Heart Surgery, The Children’s Heart Center, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
*
Correspondence to: Ali Dodge-Khatami, MD, PhD, Chief, Professor of Surgery, Pediatric and Congenital Heart Surgery, Children’s Heart Center, University of Mississippi Medical Center, 2500 North State Street, Room S345, Jackson MS 39216, United States of America. Tel: +601 984 4693; Fax: +601 984 5872; E-mail: [email protected]
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Abstract

Introduction

Debilitating patient-related non-cardiac co-morbidity cumulatively increases risk for congenital heart surgery. At our emerging programme, flexible surgical strategies were used in high-risk neonates and infants generally considered in-operable, in an attempt to make them surgical candidates and achieve excellent outcomes.

Materials and methods

Between April, 2010 and November, 2013, all referred neonates (142) and infants (300) (average scores: RACHS 2.8 and STAT 3.0) underwent 442 primary cardiac operations: patients with bi-ventricular lesions underwent standard (n=294) or alternative (n=19) repair/staging strategies, such as pulmonary artery banding(s), ductal stenting, right outflow patching, etc. Patients with uni-ventricular hearts followed standard (n=96) or alternative hybrid (n=34) staging. The impact of major pre-operative risk factors (37%), standard or alternative surgical strategy, prematurity (50%), gestational age, low birth weight, genetic syndromes (23%), and major non-cardiac co-morbidity requiring same admission surgery (27%) was analysed on the need for extracorporeal membrane oxygenation, mortality, length of intubation, as well as ICU and hospital length of stays.

Results

The need for extracorporeal membrane oxygenation (8%) and hospital survival (94%) varied significantly between surgical strategy groups (p=0.0083 and 0.028, respectively). In high-risk patients, alternative bi- and uni-ventricular strategies minimised mortality, but were associated with prolonged intubation and ICU stay. Major pre-operative risk factors and lower weight at surgery significantly correlated with prolonged intubation, hospital length of stay, and mortality.

Discussion

In our emerging programme, flexible surgical strategies were offered to 53/442 high-risk neonates and infants with complex CHDs and significant non-cardiac co-morbidity, in order to buffer risk and achieve patient survival, although at the cost of increased resource utilisation.

Keywords

CHDoutcomesneonatesintensive care
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 485 - 492
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Copyright
© Cambridge University Press 2015 

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Footnotes

*

Meeting Presentation: some contents of the abstract were presented at the 10th International Conference of the Pediatric Cardiac Intensive Care Society, Miami, Florida, USA, 11–14 December, 2014.

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