Perioperative outcomes in children with congenital heart disease when cared for by a Congenital Cardiac Anesthesiologist during Noncardiac Surgery

Abstract Background: Congenital cardiac anesthesiologists are a limited resource, but their expertise may be beneficial to children with Congenital Heart Disease (CHD) undergoing procedures outside of the cardiac operating room. Our objective was to evaluate the incidence of adverse events in patients with CHD during noncardiac surgery when their perioperative care was coordinated and executed by a congenital cardiac anesthesiologist. Methods: We conducted a retrospective cohort study at a tertiary care health system. Children with CHD were assigned one of three American College of Surgeons National Surgery Quality Improvement Program functional severity classifications (minor, major, or severe). Perioperative care was performed by a congenital cardiac anesthesiologist. Outcomes such as perioperative cardiac arrest, postoperative intubation, and survival data were compared to those reported in the literature. Results: 131 patients with CHD underwent 171 noncardiac surgical procedures. Congenital cardiac anesthesiologists primarily cared for children with major (45%) or severe (45%) CHD undergoing noncardiac surgery. An intraoperative cardiac arrest occurred in a single patient (0.6%; 95% CI 0.0–3.2) with severe CHD. Patients with severe CHD accounted for most (66.7%) of the 3.5% (CI 1.3–7.5) of patients who required postoperative reintubation. The 30-day and overall mortality rates for patients with severe CHD remained high at 13.6% (95% CI 5.2–27.4) and 18.2% (95% CI 6.8–29.6) respectively. Conclusions: Perioperative risk stratification, planning and care of pediatric patients with major or severe CHD by a dedicated team of congenital cardiac anesthesiologists is associated with a low rate of perioperative complications.