Physician-researchers from the Cardiac Center at Children's Hospital of Philadelphia (CHOP) presented new findings on pediatric cardiovascular disease at the American College of Cardiology's 67th Annual Scientific Session & Expo 2018 in Orlando, Fla. Among many abstracts presented were emergency department visits in patients with congenital heart disease, social risk factors for readmission, factors predicting mortality after prolonged critical illness and more.

Modifiable Factors Predict Mortality After Prolonged Critical Illness Following Congenital Heart Surgery

Patients who suffer prolonged critical illness (PCI) after congenital heart surgery are at high risk for mortality, yet the extent to which mortality after critical illness is preventable remains unknown. The researchers aimed to determine the modifiable and non-modifiable factors predicting mortality for patients with PCI after heart surgery at hospitals in the Pediatric Cardiac Critical Care Consortium (PC4). The team performed an observational analysis of the PC4 clinical registry of all admissions to the cardiac intensive care unit (CICU) after congenital heart surgery from August 2014 to December 2016, stratified into neonates (under 28 days) and non-neonates, and defined PCI as length of stay greater than the 90th percentile. The primary outcome was death prior to discharge from CICU. Of the 13,106 surgical episodes from 23 hospitals, the final cohort was 242 neonates and 1,184 non-neonates with PCI. Of these, 57 (24 percent) neonates and 92 (8 percent) non-neonates died in the CICU. Mechanical ventilation days, cardiac arrest, renal replacement therapy and unplanned re-operation independently predicted mortality in both groups. Time to freedom of vasoactives predicted mortality in neonates, while nitric oxide use, pre-operative comorbidities and mechanical circulatory support predicted mortality in non-neonates. Prematurity, extra-cardiac and chromosomal abnormalities, and surgical complexity were not associated with mortality in either cohort. Complications and prolonged critical care therapy drive mortality after PCI more than innate patient characteristics, particularly in neonates. Aaron Dewitt et al. "Modifiable Factors Predict Mortality After Prolonged Critical Illness Following Congenital Heart Surgery" presented at the American College of Cardiology 67th Annual Scientific Session & Expo 2018. This abstract was selected as the Best Poster.

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