Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data From the International Quality Improvement Collaborative.

BACKGROUND: Postoperative infections contribute substantially to morbidity and mortality after congenital heart disease surgery and are often preventable. We sought to identify risk factors for postoperative infection and the impact on outcomes after congenital heart surgery, using data from the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries. METHODS AND RESULTS: Pediatric cardiac surgical cases performed between 2010 and 2012 at 27 participating sites in 16 developing countries were included. Key variables were audited during site visits. Demographics, preoperative, procedural, surgical complexity, and outcome data were analyzed. Univariate and multivariable logistic regression were used to identify risk factors for infection, including bacterial sepsis and surgical site infection, and other clinical outcomes. Standardized infection ratios were computed to track progress over time. Of 14 545 cases, 793 (5.5%) had bacterial sepsis and 306 (2.1%) had surgical site infection. In-hospital mortality was significantly higher among cases with infection than among those without infection (16.7% versus 5.3%; P<0.001), as were postoperative ventilation duration (80 versus 14 hours; P<0.001) and intensive care unit stay (216 versus 68 hours; P<0.001). Younger age at surgery, higher surgical complexity, lower oxygen saturation, and major medical illness were independent risk factors for infection. The overall standardized infection ratio was 0.65 (95% confidence interval, 0.58-0.73) in 2011 and 0.59 (95% confidence interval, 0.54-0.64) in 2012, compared with that in 2010. CONCLUSIONS: Postoperative infections contribute to mortality and morbidity after congenital heart surgery. Younger, more complex patients are at particular risk. Quality improvement targeted at infection risk may reduce morbidity and mortality in the developing world.

Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia.

BACKGROUND: The current standard of care for imaging during supraventricular tachycardia (SVT) ablation uses fluoroscopy, which exposes otherwise healthy children to the potential harmful effects of radiation. OBJECTIVE: The purpose of this study was to determine whether the adjunct use of nonfluoroscopic imaging reduces radiation exposure during SVT ablation among children. METHODS: This was a prospective, controlled, single-center study of patients age ≥8 years, weight ≥25 kg, with SVT and normal cardiac anatomy. Patients were randomized to control (fluoroscopy only) or study group (fluoroscopy + AcuNav intracardiac ultrasound + NavX electroanatomic mapping), stratified by operator to one of five electrophysiologists. Fluoroscopy times (minutes) and radiation doses (mGy) were recorded, and outcomes and adverse events were noted. RESULTS: Seventy-four patients were enrolled (37 control, 37 study). Median age was 14.7 years (range 8.6-22.3 years); 61% had accessory pathways and 39% had atrioventricular nodal reentrant tachycardia. Nonfluoroscopic imaging reduced median fluoroscopy time by 59% (18.3 minutes vs 7.5 minutes, P <.001) and radiation exposure by 72% (387 vs 110 mGy, P <.001). In the study group, 26 of 37 had ≤10 minutes of fluoroscopy, including 2 with no fluoroscopy exposure and 2 with <30 seconds. Electrophysiologic procedure time was not affected by use of nonfluoroscopic imaging, but total case times were prolonged by 31 minutes (P <.001). Acute success was 97% in control and 100% in study patients, with no difference in adverse events. CONCLUSION: Use of nonfluoroscopic imaging during SVT ablation in children resulted in substantial and immediate reductions in fluoroscopy time and radiation exposure without change in acute success or adverse event rates but did increase overall procedural time.