Öz

Objective: Congenital heart diseases (CHD) frequently necessitate cardiovascular surgery (CVS) in pediatric patients. This study aimed to evaluate postoperative complications following CVS and to investigate their association with mortality.

Materials and Methods: In this retrospective study, the medical records of 124 patients who underwent CVS and were subsequently monitored in the pediatric intensive care unit were reviewed.

Results: Among the 124 patients who underwent cardiovascular surgery, 52.4% (n=65) were male. The median age was 7 months (range, 2–71). Ventricular septal defect closure (n=49) and complete atrioventricular septal defect repair (n=15) were the most frequently performed procedures. Twenty-seven patients had chromosomal anomalies, most commonly Down syndrome. No postoperative complications were observed in 95 patients. The most common complications were atelectasis, arrhythmia, and subcutaneous emphysema. Extracorporeal therapy was administered to 12 patients. Overall mortality was 8.8% (n=11). Preoperative pulmonary hypertension (PHT) was the most common cause of death. Among the deceased patients, additional factors associated with mortality include infection and lower albumin levels, while nitric oxide therapy and intraoperative cardiopulmonary bypass use were also more common, possibly reflecting greater clinical severity.

Conclusion: As the use of cardiovascular surgery for CHD continues to increase in pediatric patients, optimizing intraoperative management and promptly identifying postoperative complications are crucial for improving survival outcomes.

Anahtar Kelimeler: Congenital heart diseases, cardiac Surgical Procedures, pulmonary hypertension, postoperative complications

Kaynakça

  1. Altun M. Pediatrik kardiyovasküler cerrahi yoğun bakım ünitesinde ebeveyn memnuniyeti: Bir üniversite hastanesi örneği [Ph.D Thesis]. Istanbul, Istanbul Medipol University Institute of Health Sciences; 2019.
  2. Zan S, Yapıcıoğlu H, Erdem S, et al. Retrospective analysis of congenital heart disease in the Neonatal Intensive Care Unit at Çukurova University during a 5-year period. Çocuk Sağlığı ve Hastalıkları Derg 2015; 58(1):7-16.
  3. Van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241-7. https://doi.org/10.1016/j.jacc.2011.08.025
  4. Undar A, Bakır İ, Haydin S, et al. Türkiye’de doğumsal kalp hastalıkları cerrahisinin bugünü ve yarını. Turk Gogus Kalp Dama 2012;20(2):181-5. https://doi.org/10.5606/tgkdc.dergisi.2012.039
  5. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta‐analysis of 260 studies. Int J Epidemiol. 2019;48(2):455‐63. https://doi.org/10.1093/ije/dyz009
  6. Soares C, Vieira RJ, Costa S, Moita R, Andrade M, Guimarães H. Neurodevelopment outcomes in the first 5 years of the life of children with transposition of the great arteries surgically corrected in the neonatal period: systematic review and meta‐analysis. Cardiol Young. 2023;33(12):2471‐80. https://doi.org/10.1017/S104795112300375X
  7. Baumgartner H, De Backer J, Babu‐Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563‐645. https://doi.org/10.1093/eurheartj/ehaa554
  8. Bulut G, Ballı Ş, Atlıhan F, Meşe T, Çalkavur Ş, Olukman Ö. Retrospective evaluation of patients with congenital heart disease monitored in the neonatology department. İzmir Dr Behçet Uz Çocuk Hast Dergisi 2012;2(3):141-7. https://doi.org/10.5222/buchd.2012.141
  9. Jacobs JP, Jacobs ML, Mavroudis C, et al. Nomenclature and databases for the surgical treatment of congenital cardiac disease: an updated primer and an analysis of opportunities for improvement. Cardiol Young 2008;18:38-62. https://doi.org/10.1017/S1047951108003028
  10. Öztürk E, Kasar T, Yıldız O, Güzeltaş A, Haydin S. The retrospective evaluation of the patients in pediatric cardiac intensive care unit of cardiac surgery center. J Pediatr Emerg Intensive Care Med 2019;6(1):18. https://doi.org/10.4274/cayd.galenos.2018.60783
  11. Kumpula RS. Approaches to addressing diversity in nursing education. In: Dyson S and McAllister M (eds). Routledge International Handbook of Nurse Education (1st ed). New York: Taylor & Francis Group, 2020:318-34. https://doi.org/10.4324/9781351121675-27
  12. Sabuncu T, Demircin M, Doğan R, Yılmaz M, Aypar Ü, Paşaoğlu İ. Comparison of risk scoring systems in congenital heart surgery. Turk J Pediatr 2016;58:512-7. https://doi.org/10.24953/turkjped.2016.05.008
  13. Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-39. https://doi.org/10.1097/PCC.0000000000000350
  14. Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010;11(2):234-8. https://doi.org/10.1097/PCC.0b013e3181b806fc
  15. Brown KL, Crowe S, Franklin R, et al. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010. Open Heart 2015;2(1):e000157. https://doi.org/10.1136/openhrt-2014-000157
  16. Jacobs JP, He X, Mayer Jr JE, et al. Mortality trends in pediatric and congenital heart surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2016;102(4):1345-52. https://doi.org/10.1016/j.athoracsur.2016.01.071
  17. O’Brien SM, Jacobs JP, Pasquali SK, et al. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 1-Statistical Methodology. Ann Thorac Surg. 2015;100(3):1054-62. https://doi.org/10.1016/j.athoracsur.2015.07.014
  18. Jacobs JP, O’Brien SM, Pasquali SK, et al. The Importance of Patient-Specific Preoperative Factors: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2014;98(5):1653-8. https://doi.org/10.1016/j.athoracsur.2014.07.029
  19. Khajali Z, Mohammadi N, Toloueitabar Y, et al. Short-term outcomes following total correction of tetralogy of Fallot in adult patients. J Cardiothorac Surg. 2023;18(1):324. https://doi.org/10.1186/s13019-023-02411-1
  20. Kim H, Sung SC, Kim SH, et al. Early and late outcomes of total repair of tetralogy of Fallot: risk factors for late right ventricular dilatation. Interact Cardiovasc Thorac Surg. 2013;17(6):956-62. https://doi.org/10.1093/icvts/ivt361
  21. Khan I, Tufail Z, Afridi S, Iqbal M, Khan T, Waheed A. Surgery for Tetralogy of Fallot in Adults: Early Outcomes. Braz J Cardiovasc Surg. 2016;31(4):300-3. https://doi.org/10.5935/1678-9741.20160063
  22. Ergün S, Genç SB, Yildiz O, et al. Risk factors for major adverse events after surgical closure of ventricular septal defect in patients less than 1 year of age: a single-center retrospective. Braz J Cardiovasc Surg. 2019;34(3):335-43. https://doi.org/10.21470/1678-9741-2018-0299
  23. Davidson J, Tong S, Hancock H, Hauck A, da Cruz E, Kaufman J. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38(7):1184-90. https://doi.org/10.1007/s00134-012-2544-x
  24. Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med. 2014;15(6):529-37. https://doi.org/10.1097/PCC.0000000000000153
  25. Koponen T, Karttunen J, Musialowicz T, Pietiläinen L, Uusaro A, Lahtinen P. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 2019;122(4):428-36. https://doi.org/10.1016/j.bja.2018.12.019

Nasıl atıf yapılır

1.
Azizoğlu A, Talay MN, Orhan Ö, Kılıç Y, Turanlı EE, Albudak B, et al. Factors affecting mortality in patients during postoperative follow-up after cardiac surgery in a pediatric intensive care unit. Turk J Pediatr Dis. 2026;Early View:1-7. https://doi.org/10.12956/TJPD.2025.1295