Ann Thorac Surg. 2024 Aug 3:S0003-4975(24)00637-4. doi: 10.1016/j.athoracsur.2024.07.023. Online ahead of print.
ABSTRACT
BACKGROUND: We evaluated outcomes of neonatal cardiac surgery at hospitals affiliated with the European Congenital Heart Surgeons Association (ECHSA).
METHODS: All patients ≤30 days of life undergoing a cardiac surgical procedure during a 10 year period between January 2013 and December 2022 were selected from the ECHSA Congenital Database. Reoperations during the same hospitalization, percutaneous procedures, and noncardiac surgical procedures were excluded. A total of 12 benchmark operations were identified. Primary outcomes were 30-day mortality and in-hospital mortality. Multivariable logistic regression analysis was performed to determine independent factors associated with higher mortality. A comparison of mortality between the first 5 years and second 5 years was also performed.
RESULTS: The overall number of neonatal operations from 2013-2022 was 30,931, and 22,763 patients met the inclusion criteria of the study. The four most common procedures were: arterial switch operation (3,520/22,763=15.5%), aortic coarctation repair (3,204/22,763=14.1%), shunt procedure (2,351/22,763=10.3%), and Norwood Operation (2,115/22,763=9.23%). 30-day mortality rate was: overall population (1,342/22,763=5.9%), arterial switch (110/3,520=3.13%), Norwood Operation (339/2,115=16.0%), and hybrid operation (94/609=15.4%). In-hospital mortality rate was: overall population (2,074/22,763=9.1%), arterial switch (145/3,520=4.12%), Norwood Operation (523/2,115=24.7%), and hybrid operation (186/609=30.5%). Multivariable analysis revealed that major factors impacting mortality were high risk procedures (adjusted odds ratio=2.74 [95% confidence interval=2.33-3.23]; p<0.001), and the need for extracorporeal membrane oxygenation (11.8 [9.9-14]; p <0.001).
CONCLUSIONS: Neonatal cardiac surgery continues to pose a significant challenge, with notable mortality, particularly for neonates with functionally univentricular physiology. These data can serve as important benchmarks across Europe and offer insights regarding opportunities for improvement.
PMID:39102931 | DOI:10.1016/j.athoracsur.2024.07.023
