Predicting Factors of Surgical Mortality in Children and Adolescents Undergoing Correction of Tetralogy of Fallot

Pinheiro, Patrícia de Souza; Azevedo, Vitor Manuel Pereira; Rocha, Gabrielle

doi:10.36660/ijcs.20200394

Acessibilidade / Reportar erro

Brasil

International Journal of Cardiovascular Sciences

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Int J Cardiovasc Sci 36 • 2023 • https://doi.org/10.36660/ijcs.20200394 copy

Predicting Factors of Surgical Mortality in Children and Adolescents Undergoing Correction of Tetralogy of Fallot

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

In tetralogy of Fallot, correction surgery is a priority choice, seeing that it is desirable to minimize pulmonary hypoflow and severe hypoxemia, which result in hypoxemic crises, with sudden worsening of cyanosis, tachypnea, and, in some cases, loss of consciousness, seizures, and even death.

Objective

To evaluate the predicting factors of surgical mortality in children and adolescents undergoing correction of tetralogy of Fallot.

Methods

Retrospective cross-sectional study carried out by consulting all surgical records of the Child and Adolescent Cardiology Service of the Brazilian National Institute of Cardiology, during the period from 2007 to 2010. Results with p values < 0.05 were considered significant.

Results

The study evaluated 93 medical records. In relation to the characteristics of the population at the time of surgery, the median age was 3.69 (2.13 to 5.79) years, and 58.06% (n = 54) were male. White was the most common skin color, accounting for 55.43% (n = 51) of cases. In relation to assessment of nutritional status, median weight was 13.25 (10.10 to 17.60) kg, and body mass index was 14.49 (13.44 to 16.28) kg/m2. Down syndrome was present in 11.83% (n = 11) of the patients. All patients underwent correction surgery (n = 93, 100%). Prior cyanotic crisis was found in 53.85% (n = 49) with p = 0.013; surgical procedure duration was 218.83 ± 60.63 minutes, with p = 0.003, and lactate was 1.88 ± 1.33 mg/dL during the immediate postoperative period, with p = 0.009. Regarding the outcome of surgical death, it was found in 15.05% (n = 14) of patients. Mean follow-up lasted 5.68 ± 3.76 years.

Conclusions

According to the factors analyzed, the duration of the surgical procedure, prior cyanotic crisis, and blood lactate level may be relevant to surgical mortality.

Tetralogy of Fallot; Mortality; Surgery

Variables
	Median (p25 – p75)
Weight, kg
At birth	2.74 (2.40 – 3.10)
Surgery	13.25 (10.10 – 17.60)
Discharge	13.35 (10.82 – 18.4)
Last consultation	38.00 (26.10 – 49.50)
Delta surgery weight and discharge	−0.15 (−0.615 – 0.22)
Delta surgery weight and last consultation	24.50 (14.54 – 34.70)
Height, m
Surgery	1.09 (0.93 – 1.25)
Discharge	1.075 (0.93 – 1.18)
Surgery BMI kg/m²	14.49 (13.44 – 16.28)
Fasting time in hours	60.95 (57.00 – 84.00)
	Number (percentage)
Nutritional access route %(N)
Enteral	4 (4.76%)
Oral	80 (95.24%)
Postoperative WR %(N)	83 (98.81%)
WR 40 ml/kg %(N)	79 (95.18%)

Risk factor	Surgical mortality				p

	Yes		No

	N	Percentage	N	Percentage
Sex					0.737
Male	5	9.26	49	90.74
Female	5	12.82	34	87.18
Down syndrome					1.000
Yes	1	9.09	10	90.91
No	9	10.98	73	89.02
Cyanotic crisis					0.018
Yes	9	18.37	40	81.63
No	1	2.38	41	97.62
Vaccine schedule up to date					1.000
Yes	8	10.67	67	89.33
No	0	0.00	5	100.00
Prior BT					1.000
Yes	2	9.09	20	90.91
No	8	12.12	58	87.88
Prior echocardiogram					1.000
Yes	4	10.00	36	90.00
No	6	11.32	47	88.68
Severe PVS					0.174
Yes	1	25.00	3	75.00
No	3	3.61	80	96.39
Valve type					0.176
Biological	1	50.00	1	50.00
Monocusp	3	6.67	42	93.33
Plasty	6	13.04	40	86.96
Skin color					0.682
White	7	13.73	44	86.27
Mixed	3	9.09	30	90.91
Black	0	0.00	8	100.00
Running water					1.000
Yes	9	13.04	0	86.96
No	0	0.00	1	100.00
Sewage treatment					0.193
Yes	9	15.79	48	84.21
No	0	0.00	13	13
Nutritional access route					1.000
Enteral	0	0.00	4	100.00
Oral	2	2.50	78	97.50
Water restriction					1.000
Yes	2	2.41	81	97.59
No	0	0.00	1	100.00
Water restriction volume					0.095
20 ml/kg	0	0.00	1	100.00
25 ml/kg	0	0.00	1	100.00
40 ml/kg	1	1.27	78	98.73
50 ml/kg	0	0.00	1	100.00
100 ml/kg	1	100.00	0	0.00

Surgical mortality	Odds ratio	Standard error	Z score	95% CI		p value
Z score	2.10	2.09	0.75	0.30	4.80	0.46
Surgical age, years	0.12	0.20	−1.28	0.00	3.07	0.20
Duration of surgery, minutes	1.04	0.03	1.30	0.98	1.10	0.19
Surgeon’s exp, 20 surgeries	0.79	2.19	−0.09	0.00	82.35	0.93
Prior cyanotic crisis	7.58	8.78	1.57	0.01	5.41	0.12
Hemoglobin, mg/dL	0.21	0.26	−1.24	0.02	2.45	0.21
Potassium, mg/dL	43.70	140.57	1.17	0.08	239.57	0.24
Lactate, mg/dL	46.41	111.48	1.60	0.42	514.02	0.11
Creatinine, mg/dL	12.92	1.36	1.34	0.00	1.14	0.18
CPB time, minutes	1.01	0.03	0.38	0.95	1.07	0.70

Surgical mortality	Odds ratio	Standard error	Z score	95% CI		p value
Duration of surgery, minutes	1.02	0.01	2.96	1.01	1.04	0.003
Prior cyanotic crisis	189.91	402.71	2.47	2.98	121.68	0.013
Lactate, mg/dL	3.22	1.45	2.60	1.33	7.78	0.009

Sociedade Brasileira de Cardiologia Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil
E-mail: revistaijcs@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing Address: Patrícia de Souza Pinheiro Instituto Nacional de Cardiologia, Serviço de Nutrição. Rua das Laranjeiras, 374, Rio de Janeiro, RJ. Postal code: 22240-006 – Brazil E-mail: pspinheiro30@yahoo.com.br