Articles, Issue 2/2024

Risk Stratification Models for Congenital Heart Surgery in Children: Single-center Study

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D. Pechilkov, L. Simeonov, Z. Vasileva, K. Nenova, A. Kaneva, V. Boshnakov, L. Bakalivanov

Abstract

Introduction. Congenital Heart Diseases (CHD) significantly contributes to infant mortality, with a global incidence rate of approximately 8-10 per 1,000 live births. Surgical treatment is feasible in most of the cases with low operative mortality under 5% in most of the surgical centers. However, complex CHD requiring advanced surgical techniques and extensive skills and experience are still associated with a high risk of complications and mortality. Attempting to predict this risk even preoperatively, several risk stratification models for congenital heart surgery in children have been developed.

Methods. The study was a retrospective single center cohort study. Medical files of patients 0-18y who underwent heart surgery for 5 years period (2016-2020) were reviewed. The focus was on assessing the risk of early operative mortality using the RACHS-1 scoring system.

Results. 993 children were operated and 973 of them were included in the study. With the increasing complexity of surgical correction according to the RACHS-1 system, the risk of adverse outcome becomes higher (category 1 – 0% mortality, category 2 – 18.8%, category 3 – 36%, category 4 – 36%, categories 5+6 – 50%).

Conclusions. The RACHS-1 risk scoring system for congenital heart surgery in children is feasible and highly effective in predicting operative mortality.

Conclusion. Risk assessment systems after heart surgery in children are an essential tool for predicting the outcomes. They can be helpful in surgical activity planning, given the limited resources of intensive care beds and staff, which have been an ongoing trend in recent years in Bulgaria and Europe.

Key words: children, congenital heart disease, congenital heart surgery, mortality, RACHS-1

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Address for correspondence

Department of Pediatric Cardiology,

National Heart Hospital

65, “Konyovitsa”, Str.,

1309, Sofia

Bulgaria

e-mail: pe4ilkov@gmail.com