Öz
Giriş
Bu çalışma, 2015 yılında çocuk kalp cerrahisinin başladığı tek bir merkezde doğuştan kalp hastalığı olan çocukların cerrahi sonrasında izlem sırasında gözlenen sonuçları ve klinik durumları değerlendirmeyi amaçlamaktadır.
Yöntemler
1 Ekim 2015 ile 31 Aralık 2021 tarihleri arasında kalp cerrahisi geçiren pediatrik hastaların geriye dönük bir analizi yapılmıştır. Demografik, preoperatif, perioperatif ve postoperatif veriler; ekokardiyografi raporları, perfüzyon raporları ve klinik kayıtlardan toplanmıştır. İstatistiksel analizler uygun yöntemler kullanılarak gerçekleştirilmiştir.
Bulgular
Toplam 692 çocuk hasta doğuştan kalp hastalığı nedeniyle cerrahi işlem geçirdi. En yaygın görülen kusurlar ventriküler septal defekt, atriyal septal defekt ve fallot tetralojisiydi. Preoperatif risk faktörleri arasında en sık malnütrisyon ve büyüme geriliği bulunmaktaydı. En sık solunum sorunları, aritmiler ve akut böbrek hasarı gibi komplikasyonlar gözlemlendi. Genel mortalite oranı %3,6 idi. Mortalite oranları belirli doğuştan kalp hastalığı kusurları ve risk kategorilerine bağlı olarak değişiyordu.
Sonuç
Bu çalışma, çocuk doğuştan kalp hastalığı hastalarının cerrahi sonrası takibi konusunda değerli veriler sunarak, risk gruplarının, preoperatif değerlendirmenin ve postoperatif bakımın önemini vurgulamaktadır. Bulgular, doğuştan kalp hastalığı yönetimi ve sonuçları konusunda katkıda bulunmaktadır. Bu hastalarda uzun dönem sonuçların değerlendirilmesi, risklerin azaltılması, mortalite ve komplikasyonları azaltmaya yönelik stratejilerin geliştirilmesi hedeflenerek çalışmaların yapılması gerekmektedir.
Anahtar Kelimeler: Pediyatrik kalp cerrahisi, çocuk yoğun bakım ünitesi, komplikasyonlar, sonuçlar
Kaynakça
Qu Y, Liu X, Zhuang J, Chen G, Mai J, et al. Incidence of congenital heart disease: The 9-year experience of the guangdong registry of congenital heart disease, China. PLoS One. 2016;11:e0159257.
Bouma BJ, Mulder BJM. Changing landscape of congenital heart disease. Circ Res. 2017;120:908-22.
Khasawneh W, Hakim F, Abu Ras O, Hejazi Y, Abu-Aqoulah A. Incidence and patterns of congenital heart disease among jordanian infants, a cohort study from a university tertiary center. Front Pediatr. 2020;8:219.
Zimmerman MS, Smith AGC, Sable CA, Echko MM, Wilner LB, et al. Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health. 2020;4:185-200.
Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine (Baltimore). 2020;99:e20593.
Kaltman JR, Andropoulos DB, Checchia PA, Gaynor JW, Hoffman TM, et al. Report of the Pediatric Heart Network and National Heart, Lung, and Blood Institute Working Group on the Perioperative Management of Congenital Heart Disease. Circulation. 2010;121:2766-72.
O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009;138:1139-53.
Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123:110-8.
Agarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP. Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2014;148:609-16.e1.
Mirzaei M, Mirzaei S, Sepahvand E, Koshkaki AR, Kargar Jahromi M. Evaluation of Complications of Heart Surgery in Children With Congenital Heart Disease at Dena Hospital of Shiraz. Glob J Health Sci. 2015;8:33-8.
Vener DF, Gaies M, Jacobs JP, Pasquali SK. Clinical Databases and Registries in Congenital and Pediatric Cardiac Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide. World J Pediatr Congenit Heart Surg. 2017;8:77-87.
World Database For Pediatric And Congenital Heart Surgery. Available from: www.uab.edu/medicine/wdps/
Soler YA, Nieves-Plaza M, Prieto M, García-De Jesús R, Suárez-Rivera M. Pediatric risk, injury, failure, loss, end-stage renal disease score identifies acute kidney injury and predicts mortality in critically ill children: a prospective study. Pediatr Crit Care Med. 2013;14:e189-95.
Part IV – the dictionary of definitions of complications associated with the treatment of patients with congenital cardiac disease. Cardiol Young. 2008;18:282-530.
Squires JE, McKiernan PJ, Squires RH; Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Collaborative. Acute Liver Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference. Pediatrics. 2022;149(1 Suppl 1):S59-S65.
Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2-8.
Boehne M, Sasse M, Karch A, Dziuba F, Horke A, et al. Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome. J Card Surg. 2017;32:116-25.
Erek E, Yalçınbaş YK, Sarıosmanoğlu N, Özkan M, Yıldız O, et al. First harvest of pediatric and congenital heart surgery multicenter database in Turkey: Novel application of real-time online reporting. World J Pediatr Congenit Heart Surg. 2021;12:377-86.
St Louis JD, Deng L, Covington C, Timkovich NA, Crethers D, et al. The World Society for Pediatric and Congenital Heart Surgery: 2021 Update of the World Database for Pediatric and Congenital Heart Surgery. World J Pediatr Congenit Heart Surg. 2022;13:137-45.
Javed F, Aleysae NA, Al-Mahbosh AY, Zubani AA, Atash AM, et al. Complications after surgical repair of congenital heart disease in infants. An experience from tertiary care center. J Saudi Heart Assoc. 2021;33:271-8.
Hornik CP, He X, Jacobs JP, Li JS, Jaquiss RD, et al. Complications after the Norwood operation: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2011;92:1734-40.
Murni IK, Djer MM, Yanuarso PB, Putra ST, Advani N, et al. Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Ann Pediatr Cardiol. 2019;12:38-44.
Pedersen KR, Povlsen JV, Christensen S, Pedersen J, Hjortholm K, et al. Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta Anaesthesiol Scand. 2007;51:1344-9.
Tóth R, Breuer T, Cserép Z, Lex D, Fazekas L, et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg. 2012;93:1984-90.
Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 2011;39:1493-9.
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343-8.
Van den Eynde J, Rotbi H, Gewillig M, Kutty S, et al. In-hospital outcomes of acute kidney injury after pediatric cardiac surgery: A meta-analysis. Front Pediatr. 2021;9:733744.
Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017;376:11-20.
Öztürk E, Kafalı HC, Tanıdır İC, Tunca Şahin G, Onan İS, et al. Early postoperative arrhythmias in patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2021;29:27-35.
Tabib A, Abrishami SE, Mahdavi M, Mortezaeian H, Totonchi Z. Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease. Res Cardiovasc Med. 2016;5:e30391.
Koski T, Salmi H, Keski-Nisula J, Bille A, Björnsson E, et al. A retrospective analysis of the duration of mechanical ventilation in Scandinavian paediatric heart centres. Acta Paediatr. 2022;111:859-65.
Mirabel M, Lachaud M, Offredo L, Lachaud C, Zuschmidt B, et al. Cardiac surgery in low-income settings: 10 years of experience from two countries. Arch Cardiovasc Dis. 2017;110:82-90.
