ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Second harvest of Congenital Heart Surgery Database in Türkiye: Current outcomes
Ersin Erek1,15, Serdar Başgöze1, Okan Yıldız2, Nejat Osman Sarıosmanoğlu3, Yusuf Kenan Yalçınbaş4,15, Rıza Turköz4, Ali Kutsal5, Serkan Seçici6, Servet Ergün7, Vladimir Chadikovski8, Ahmet Arnaz4, Murat Koç5, Oktay Korun9, Işık Şenkaya10, Fatih Özdemir11, Mehmet Biçer12, Bülent Sarıtaş13, Yüksel Atay14, Sertaç Haydın2, Çağatay Bilen3, İsmihan S. Onan2, Osman N. Tuncer14, Görkem Citoglu10, Abdullah Dogan4, Bahar Temur1, Murat Özkan16, C. Tayyar Sarioglu1
1Department of Pediatric Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, Acıbadem Atakent Hospital, İstanbul, Türkiye
2Department of Pediatric Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
3Department of Pediatric Cardiovascular Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
4Department of Pediatric Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Türkiye
5Department of Pediatric Cardiovascular Surgery, Sami Ulus Gynecology and Pediatrics Training and Research Hospital, Ankara, Türkiye
6Department of Pediatric Cardiovascular Surgery, Medicana Hospital, Bursa, Türkiye
7Department of Pediatric Cardiovascular Surgery, Erzurum Training and Research Hospital, Erzurum, Türkiye
8Department of Pediatric Cardiovascular Surgery, Acıbadem Sistina Hospital, Skopje, North Macedonia
9Department of Pediatric Cardiovascular Surgery, Cerrahpaşa University Faculty of Medicine, İstanbul, Türkiye
10Department of Pediatric Cardiovascular Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
11Department of Pediatric Cardiovascular Surgery, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
12Department of Pediatric Cardiovascular Surgery, Koç University Faculty of Medicine, İstanbul, Türkiye
13Department of Pediatric Cardiovascular Surgery, İstanbul Aydin University, İstanbul, Türkiye
14Department of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Türkiye
15Children?s Heart Foundation, Board of Directors, İstanbul, Türkiye
16Department of Pediatric Cardiovascular Surgery, Başkent University Faculty of Medicine, Ankara, Türkiye
DOI : 10.5606/tgkdc.dergisi.2024.25758
Background: This second harvest of the Congenital Heart Surgery Database intended to compare current results with international databases.

Methods: This retrospective study examined a total of 4007 congenital heart surgery procedures from 15 centers in the Congenital Heart Surgery Database between January 2018 and January 2023. International diagnostic and procedural codes were used for data entry. STAT (Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery) mortality scores and categories were used for comparison of the data. Surgical priority status was modified from American Society of Anesthesiologist guidelines. Centers that sent more than 5 cases to the database were included to the study.

Results: Cardiopulmonary bypass and cardioplegic arrest were performed in 2,983 (74.4%) procedures. General risk factors were present in 22.6% of the patients, such as genetic anomaly, syndrome, or prematurity. Overall, 18.9% of the patients had preoperative risk factors (e.g., mechanical ventilation, renal failure, and sepsis). Of the procedures, 610 (15.2%) were performed on neonates, 1,450 (36.2%) on infants, 1,803 (45%) on children, and 144 (3.6%) on adults. The operative timing was elective in 56.5% of the patients, 34.4% were urgent, 8% were emergent, and 1.1% were rescue procedures. Extracorporeal membrane oxygenation support was used in 163 (4%) patients, with a 34.3% survival rate. Overall mortality in this series was 6.7% (n=271). Risk for mortality was higher in patients with general risk factors, such as prematurity, low birth weight neonates, and heterotaxy syndrome. Mortality for patients with preoperative mechanical ventilation was 17.5%. Pulmonary hypertension and preoperative circulatory shock had 11.6% and 10% mortality rates, respectively. Mortality for patients who had no preoperative risk factor was 3.9%. Neonates had the highest mortality rate (20.5%). Intensive care unit and hospital stay time for neonates (median of 17.8 days and 24.8 days, respectively) were also higher than the other age groups. Infants had 6.2% mortality. Hospital mortality was 2.8% for children and 3.5% for adults. Mortality rate was 2.8% for elective cases. Observed mortality rates were higher than expected in the fourth and fifth categories of the STAT system (observed, 14.8% and 51.9%; expected, 9.9% and 23.1%; respectively).

Conclusion: For the first time, outcomes of congenital heart surgery in Türkiye could be compared to the current world experience with this multicenter database study. Increased mortality rate of neonatal and complex heart operations could be delineated as areas that need improvement. The Congenital Heart Surgery Database has great potential for quality improvement of congenital heart surgery in Türkiye. In the long term, participation of more centers in the database may allow more accurate risk adjustment.

Keywords : Cardiac surgery, congenital heart disease, database, quality improvement
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