Outcomes of Neonatal Cardiac Surgery: A European Congenital Heart Surgeons Association Study

Abstract

Background: We evaluated outcomes of neonatal cardiac surgery at hospitals affiliated with the European Congenital Heart Surgeons Association (ECHSA).

Methods: All patients ≤30 days of life undergoing a cardiac surgical procedure during a 10-year period between January 2013 and December 2022 were selected from the ECHSA Congenital Database. Reoperations during the same hospitalization, percutaneous procedures, and noncardiac surgical procedures were excluded. We identified 12 benchmark operations. Primary outcomes were 30-day mortality and in-hospital mortality. Multivariable logistic regression analysis was performed to determine independent factors associated with higher mortality. Mortality between the first 5 years and second 5 years was also compared.

Results: The overall number of neonatal operations from 2013 to 2022 was 30,931, and 22,763 patients met the inclusion criteria of the study. The 4 most common procedures were arterial switch operation (3520 of 22,763 [15.5%]), aortic coarctation repair (3204 of 22,763 [14.1%]), shunt procedure (2351 of 22,763 [10.3%]), and Norwood operation (2115 of 22,763 [9.23%]). The 30-day mortality rate was as follows: overall population, 5.9% (1342 of 22,763); arterial switch, 3.13% (110 of 3520); Norwood operation, 16.0% (339 of 2115); and hybrid operation, 15.4% (94 of 609). In-hospital mortality rate was as follows: overall population, 9.1% (2074 of 22,763); arterial switch, 4.12% (145 of 3520); Norwood operation, 24.7% (523 of 2115); and hybrid operation, 30.5% (186 of 609). Multivariable analysis revealed that major factors impacting mortality were high-risk procedures (adjusted odds ratio, 2.74; 95% CI, 2.33-3.23; P < .001), and the need for extracorporeal membrane oxygenation (11.8; 95% CI, 9.9-14; P < .001).

Conclusions: Neonatal cardiac surgery continues to pose a significant challenge, with notable mortality, particularly for neonates with functionally univentricular physiology. These data can serve as important benchmarks across Europe and offer insights regarding opportunities for improvement.