The outcome of surgery for congenital heart disease in India: A systematic review and metanalysis

Abstract

Background: The mortality risks of children undergoing various cardiac surgeries for congenital heart disease (CHD) in India are not well defined. We conducted a systematic review and meta-analysis to estimate the inhospital mortality of various common CHD surgeries reported in India and compared it to representative data from established Western databases.

Methods and results: We searched four bibliographic databases for studies published in India over the last 25 years. In total, 135 studies met the inclusion criteria and included 30,587 patients aged from 1 day to 65 years. The pooled mortality rate of 43 Indian studies reporting multiple CHD surgical outcomes is 5.63% (95% confidence interval [CI]: 4.26-7.16; I ² = 93.9%), whereas the Western data showed a pooled mortality rate of 2.65% (P value for comparison <0.0001). The pooled mortality risk for ventricular septal defect closure and tetralogy of Fallot repair in Indian studies was 2.87% (95% CI: 0.76-5.91; I ² = 62.4%) and 4.61% (95% CI: 2.0-8.02; I ² = 87.4%), respectively. The estimated mortality risk was higher than the Western databases for all subcategories studied except for surgeries in the grown-ups with CHD population and coarctation repair.

Conclusions: The estimated mortality risks are higher among Indian patients undergoing cardiac surgery for CHD as compared to Western data. We need prospective multicentric data to document whether the observed excess mortality exists after adjusting for various high-risk features and comorbidities in Indian patients. We need systemic measures to improve the outcomes of CHD surgeries in India.

Keywords: Operative mortality; congenital heart surgery; low- and middle-income countries; pooled mortality risk.

Figure 1

Schematic flow chart showing the selection of studies

Figure 2

Pooled analysis of in-hospital mortality reported by pediatric cardiac surgery studies from India[10161718192021222324252627282930313233343536373839404142434445464748495051525354]

Figure 3

Pooled analysis of in-hospital mortality reported by Indian studies – Selected surgeries for acyanotic congenital heart diseases (VSD,[5758596061626364] APW,[65666768697071] COA[72737475]). VSD: Ventricular septal defect, APW: Aortopulmonary window, COA: Coarctation of the aorta. (Reddy C, et al. (2022) Single comparative study of APW simple versus complex groups[69])

Figure 4

Pooled analysis of in-hospital mortality reported by Indian studies – Selected surgeries for cyanotic congenital heart diseases. (TGA,[767778798081828384148] TAPVC,[85868788899091929394] TOF[9596979899100101102103104105106107108109110111112]). TGA: Transposition of great arteries, TAPVC: Total anomalous pulmonary venous connection, TOF: Tetralogy of Fallot

Figure 5

Pooled analysis of in-hospital mortality reported by Indian studies – Selected palliative surgeries (PAB,[113114115116] BTS,[117118119120121122145] BDG,[123124125126127128] Fontan[129130131]). PAB: Pulmonary artery banding, BTTS: Blalock-Taussig-Thomas shunt, BDG: Bidirectional Glenn. (Chowdhury et al. (2001)[125] single comparative study of outcomes of BDG based on two groups before and after 2 years of age)

Figure 6

Pooled analysis of in-hospital mortality reported by Indian studies involving the GUCH population[91130132133134135136137138139140141142143]