Practical conduct of open heart procedures for congenital heart lesions

Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry - a descriptive analysis

OBJECTIVE

This study aimed to assess the International Quality Improvement Collaborative single-site data from a developing country to identify trends in outcomes and factors associated with poor outcomes.

DESIGN

Retrospective descriptive study.

SETTING

The National Institute of Cardiovascular Diseases, Karachi, Pakistan.

PARTICIPANTS

Patients undergoing surgery for congenital heart disease (CHD).

OUTCOME MEASURE

Key factors were examined, including preoperative, procedural and demographic data, as well as surgical complications and outcomes. We identified risk factors for mortality, bacterial sepsis and 30-day mortality using multivariable logistic regression.

RESULTS

A total of 3367 CHD surgical cases were evaluated; of these, 59.4% (2001) were male and 82.8% (2787) were between the ages of 1 and 17 years. Only 0.2% (n=6) were infants (≤30 days) and 2.3% (n=77) were adults (≥18 years). The in-hospital mortality rate was 6.7% (n=224), and 4.4% (n=147) and 0.8% (n=27) had bacterial sepsis and surgical site infections, respectively. The 30-day status was known for 90.8% (n=3058) of the patients, of whom 91.6% (n=2800) were alive. On multivariable analysis, the adjusted OR for in-hospital mortality was 0.40 (0.29-0.56) for teenagers compared with infancy/childhood and 1.95 (1.45-2.61) for patients with oxygen saturation <85%. Compared with Risk Adjustment for Congenital Heart Surgery (RACHS-1) risk category 1, the adjusted OR for in-hospital mortality was 1.78 (1.1-2.87) for RACHS-1 risk category 3 and 2.92 (1.03-8.31) for categories 4-6. The adjusted OR for 30-day mortality was 0.40 (0.30-0.55) for teenagers and 1.52 (1.16-1.98) for patients with oxygen saturation <85%. The 30-day mortality rate was significantly higher in RACHS-1 risk category 3 compared with category 1, with an adjusted OR of 1.64 (1.06-2.55).

CONCLUSIONS

We observed a high prevalence of postoperative infections and mortality, especially for high-risk procedures, according to RACHS-1 risk category, in infancy/childhood, in children with genetic syndrome or those with low oxygen saturation (<85%).

A unique presentation of anomalous posterior intercostal veins, hemiazygos vein and left superior vena cava

The venous anomalies of thorax are common, but the only drainage of 1st and 2nd posterior intercostal veins on both sides into the internal vertebral venous plexus with no communication to the azygos system is reported for the first time. The common hemiazygos vein is singular receiving all the posterior intercostal veins on the left from 4th to the 11th with subcostal on the left side. This vein drains into azygos on the right. It also connects on the cranial end via an anomalous vein to the Left SVC. This anomalous vein also receives the left 3rd posterior intercostal vein. On the right, the azygos system is normal.