Analysis of 14,843 neonatal congenital heart surgical procedures in the European Association for Cardiothoracic Surgery Congenital Database.

BACKGROUND

Early outcomes of congenital heart surgery in neonates have significantly improved during the last decade. Further improvements require identification of specific risk factors correlating with early mortality and morbidity.

METHODS

Between January 1999 and May 2008 data on 14,843 congenital heart procedures performed in 118 congenital heart surgery centers in 34 countries were submitted to the European Association for Cardiothoracic Surgery Congenital Database. Mean age at surgery was 11.8 days and mean body weight was 2.9 kg. Multivariate stepwise regression analysis was used to assess the risk factors for postoperative complications and death.

RESULTS

Thirty-day mortality of 9.1% was significantly different from hospital mortality (10.7%). Postoperative complications occurred in 29.2% of neonates. In multivariate analysis, early death rate was statistically significantly modified by body weight, Aristotle basic score (ABS), cardiopulmonary bypass time (CPB time), aortic cross-clamp time, circulatory arrest time, and univentricular physiology. The rate of complications was associated with ABS, CPB time, and circulatory arrest time.

CONCLUSIONS

In neonatal congenital heart surgery significant risk of early death extends beyond 30 postoperative days. Multivariate analysis confirmed that lower body weight, higher ABS, longer CPB time, longer aortic cross-clamp time, longer circulatory arrest time, and univentricular physiology are risk factors for hospital mortality. Higher ABS as well as longer CPB time and circulatory arrest time are associated with the rate of complications.