Ejigu Yayehyirad, Mlambo Vongai C, Neil Kara L, Sime Habtamu, Wong Rex, Gatera Michel R, Nyirigira Gaston, Sewnet Yilkal C, Lin Yihan, Byishimo Bertrand, Rukomeza Gloria, Mutabandama Yves, Rusingiza Emmanuel
King Faisal Hospital Rwanda, #66 KG 5 Avenue, Kacyiru, Kigali, Rwanda.
Stanford University School of Medicine, Stanford, CA, USA.
J Cardiothorac Surg. 2024 Dec 31;19(1):699. doi: 10.1186/s13019-024-03295-5.
While the number of cardiac surgery programs in sub-Saharan Africa are increasing, it is still insufficient. With only 0.08 pediatric cardiac surgeons per million people, few cardiac centers routinely perform pediatric cardiac surgery. This has led to reliance on humanitarian medical missions or referral abroad for most African nations. This study outlines the outcomes of Rwanda's first sustainable pediatric cardiac surgery program.
A retrospective chart review was performed for all pediatric patients who received cardiac surgery between October 2022 and April 2024. Patient demographics, procedures, operative times, length of stay, complications, and 30-day mortality were synthesized. Perioperative factors associated with complications and prolonged intensive care unit length of stay were evaluated using logistic and linear regression analysis, respectively.
207 patients received 240 cardiac procedures. At time of surgery, 45% of patients were 1-5 years old (n = 95). The top five procedures were repair of Ventricular Septal Defect, Patent Ductus Arteriosus, Atrial Septal Defect, Tetralogy of Fallot and Coarctation of the Aorta. 30-day mortality was 1.9% (n = 4) and 6.3% (n = 13) experienced a major complication. Additionally, 24% (n = 50) experienced minor complications, most commonly, pneumonia. The linear combination of surgery duration, cross clamp and bypass time was significantly associated with having complications (aOR = 0.67, p = 0.01). Younger age, longer operative times, number of inotropes and the presence of complications were associated with an increased intensive care unit stay.
The 30-day surgical outcomes are favorable compared to programs with a similar case mix, showing that pediatric cardiac surgery can be safely performed in developing countries with local cardiac teams. Prolonged bypass and cross clamp times were associated with higher complication rates and increased inotrope use was associated with longer intensive care unit stay.
尽管撒哈拉以南非洲地区心脏外科手术项目的数量在增加，但仍不足。每百万人中仅有0.08名小儿心脏外科医生，很少有心脏中心常规开展小儿心脏手术。这导致大多数非洲国家依赖人道主义医疗任务或转诊至国外。本研究概述了卢旺达首个可持续小儿心脏手术项目的成果。
对2022年10月至2024年4月期间接受心脏手术的所有小儿患者进行回顾性病历审查。综合患者人口统计学、手术、手术时间、住院时间、并发症和30天死亡率。分别使用逻辑回归和线性回归分析评估与并发症和延长重症监护病房住院时间相关的围手术期因素。
207例患者接受了240例心脏手术。手术时，45%的患者年龄在1至5岁之间（n = 95）。前五项手术为室间隔缺损修补术、动脉导管未闭结扎术、房间隔缺损修补术、法洛四联症矫治术和主动脉缩窄矫治术。30天死亡率为1.9%（n = 4），6.3%（n = 13）发生了严重并发症。此外，24%（n = 50）发生了轻微并发症，最常见的是肺炎。手术持续时间、主动脉阻断时间和体外循环时间的线性组合与发生并发症显著相关（调整后比值比 = 0.67，p = 0.01）。年龄较小、手术时间较长、使用血管活性药物的数量以及存在并发症与重症监护病房住院时间延长相关。
与病例组合相似的项目相比，30天手术结果良好，表明当地心脏团队可以在发展中国家安全地开展小儿心脏手术。体外循环和主动脉阻断时间延长与较高的并发症发生率相关，血管活性药物使用增加与重症监护病房住院时间延长相关。
