“PEDIATRIC CONGENITAL HEART DISEASE SURGERY IN SHISONG: DETERMINANTS OF EARLY POST OPERATIVE OUTCOME”

Fung Holgar Mua (holgnice85@yahoo.com)
Internal medicine, University of Yaounde 1
June, 2013
 

Abstract

Introduction
In Cameroon, congenital heart diseases are estimated to represent 0.987% of live births. Without treatment, most of these children will die of complications. Access to proper healthcare for children with CHD is inadequate in most developing Countries. Furthermore, issues such as late presentation of cases, understaffing of units and limited resources contribute to suboptimal outcome in those who undergo surgery, leading to high morbidity and mortality. Since the introduction of open heart surgery in Cameroon in 1985, followed by the inauguration of the Shisong Cardiac Centre in November 2009, little is known about the outcome of children undergoing CHD surgery. Consequently, we sought to investigate the relation between postoperative morbidity and mortality rates and variables occurring before, during, and after, in children who underwent CHD surgery.

Objective
Our main objective was to determine the early post-operative outcome. Specifically, to describe the clinical and demographic characteristics of the study population, to describe the profile of congenital heart defects, to identify pre-operative, intra-operative and post-operative factors that determine outcome and to establish a predictor model for outcome using the logistic regression technique.

Methods
Hospital records of 74 consecutive children who underwent surgical intervention between January 1st 2010 and December 31st 2012 were reviewed. Pre, per and post-operative variables were recorded. Main outcome measure was in hospital mortality. Secondary outcome measures were postoperative sepsis and hospital stay of longer than 10 days. Multivariate logistic regression analysis was performed to see predictors of outcome.

Results
Overall mortality was 9.46%, with leading causes of mortality being Arrhythmia (1), postoperative sepsis (2), low cardiac output state (2), pulmonary hypertensive complications (1), and acute renal failure (1).Mortality was significantly high for cyanotic lesions 15.6 % against 4.8% for acyanotic lesions (P<0.0001). Major post-operative complications occurred in 40.5%, with arrhythmia being the highest 13.5%, Arrhythmia was common among acyanotic defects than cyanotic defects.The proportion of postoperative sepsis was 6.8%. Postoperative sepsis was significantly higher among cyanotic defects 12.5% than in acynotic CHD 2.4% (P=0.006). There was no significant difference in prolonged length of hospital stay between cyanotic and acyanotic defects (P=0.36). Predictors of outcome on multivariate analysis were as follows: (1) Mortality (Predictive power 96.8%)—corrective procedure (Odds Ratio 2.1), preoperative sepsis(Odds Ratio 5.5), pulmonary hypertension (Odds Ratio 7.3), Heart failure (Odds Ratio 12.3), need for inotropic support (Odds Ratio 8.5). (2)Prolonged hospital stay (Predictive power 93.2%)—Need for inotropic support (Odds Ratio 1.6), ICU duration>3days (Odds Ratio 2.1), and arrhythmia (Odds Ratio 6.2): and (3) Post-operative sepsis(Predictive power 73.9%)--cyanotic CHDOR:(2.0),preoperative sepsis(Odds Ratio 35.4), wound infection(Odds Ratio 4.1) and corrective procedure(Odds Ratio 4.4).

Conclusion: From our results, we can conclude that, with increasing experience, congenital heart disease surgery can be performed with excellent outcomes in Cameroon despite resource limitations. Though we observed an acceptable mortality rate of (9.46%), the risk of dying in-hospital was much higher in complex Cyanotic CHD. Heart failure and infectious complications contributed to mortality while, arrhythmia contributed significantly to post-operative morbidity. Most of the patients were from regions with referral hospitals and high population densities. Acyanotic CHD was more frequent than cyanotic CHD. VSD was commonest in acyanotic CHD and TOF in cyanotic CHC.


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