Pediatric Cardiology

Biography

Biography: Ali Dodge-Khatami

Abstract

Introduction: Debilitating patient-related non-cardiac comorbidity cumulatively increases risk for congenital heart surgery. At our emerging program, flexible surgical strategies were employed in high-risk neonates and infants generally considered inoperable, in an attempt to make them surgical candidates and achieve excellent outcomes. Materials & Methods: Between April 2010 and November 2013, all referred neonates (143) and infants (308) (average scores: RACHS 2.8 and STAT 3.0) underwent 451 primary cardiac operations: Biventricular lesions underwent standard (n=294) or alternative (n=19) repair/staging strategies (pulmonary artery banding(s), ductal stenting, right outflow patching). Uni-ventricular hearts followed standard (n=103) or alternative hybrid (n=35) staging. The impact of major pre-operative risk factors (37%), standard or alternative surgical strategy, prematurity (44%), gestational age, low birth weight, genetic syndromes (23%), and major non-cardiac comorbidity requiring same admission surgery (27%) was analyzed on need for extracorporeal membrane oxygenation (ECMO), mortality, length of intubation, intensive care unit (ICU) and hospital stays.
Results: ECMO need (8%) and hospital survival (94%) varied significantly between surgical strategy groups (p=0.01 and p=0.0384, respectively). In high-risk patients, alternative bi and uni-ventricular strategies minimized 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 program, flexible surgical strategies were offered to 54/451 high-risk neonates and infants with complex congenital heart defects and significant non-cardiac comorbidity, in order to buffer risk and achieve patient survival, albeit at the cost of increased resource utilization.