Newborn Cardiac Surgery Survival
Performing heart surgery on newborn babies is more challenging due to the young age and small size of the patients. By comparing newborn survival rates along with STAT category, parents can get an idea of how well the surgeons perform in the most challenging cases.
What we measure:
We compare our survival rates for newborn patients with national averages by the complexity of the surgery.
What it means:
At Childrens Colorado, our surgeons have extensive experience correcting heart defects in even the youngest patients some just a few hours old. Our survival rates for STAT 1, STAT 2 and STAT 5 cases are higher than the national averages.
How Does Sts Define Surgical Mortality
STS defines surgical mortality as the percentage of heart surgery patients who pass away during their operation or, if they have been discharged, within 30 days of their surgery. Mortality also includes the patients who are not discharged within 30 days but pass away during their hospitalization.
These STS definitions ensure that institutions across the country are using consistent data reporting methods.
Why Is This Important
The research team says one of their aims in this project was to empower patients. Parents said it helped to know they were not alone in facing complications, that clinical teams had seen the complications before and knew how to deal with them.
Over the course of the project, the researchers kept in close contact with the organisation that monitors the outcomes of childrens heart surgery, called the National Congenital Heart Diseases Audit , and with those responsible for designing specialist health services. These groups now use the same definitions when talking about the complications of childrens heart surgery, and hospitals across the UK now use the list when recording what happens to children after their surgery.
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Cardiac Surgery Survival Rates By Complexity
Some congenital heart defects are more complex than others. And because there are so many types of heart defects, no pediatric heart program will see the exact same defects each year.
The Society of Thoracic Surgeons , the organization with the largest congenital heart surgery database, organizes the types of surgeries into five categories, which are referred to as STAT categories so they are easier to compare.
What Is The Survival Rate Of Heart Surgery
Heart surgery survival rates vary based on the type of surgery and how many problems are repaired during the operation. Survival rates are:
- Mitral valve repair for mitral valve prolapse: 100%.
- Aortic valve replacement: 98.1%.
- Coronary artery bypass surgery : 97.8%.
Heart surgery is generally riskier for people who are very ill or have other medical conditions.
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What Happens During Open
Heart surgery is complex. Some surgeries may take six hours or longer. You will receive anesthesia and be asleep during the procedure.
Surgery steps vary depending on the heart condition and procedure. In general, your surgeon:
- Makes a 6- to 8-inch long incision down the middle of your chest.
- Cuts the breastbone and spreads your ribcage apart to reach your heart.
- Connects the heart to a heart-lung bypass machine, if youll have an on-pump surgery. An anesthesiologist gives IV medication to stop your heart from beating and monitors you during the surgery.
- Repairs your heart.
- Restores blood flow to your heart. Usually, your heart starts beating on its own. Sometimes, the heart needs a mild electrical shock to restart it.
- Disconnects the heart-lung bypass machine.
- Closes the breastbone or other incision with wires or sutures that remain in your body.
- Uses stitches to close the skin incision.
What Is The Mortality Rate For Open Heart Surgery
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Differences In Outcome Measures
Our results show that mortality rates can vary largely depending on the cut-off point used for the follow-up. Mortality at discharge or at 30 days is more than doubled after 1 year. Previous studies found similar results. Edwards and Taylor studied over 80 000 patients in the UK Heart Valve Registry and found almost a doubling of the mortality rate after 1 year, when compared with 30 days.
In-hospital mortality and 30-day mortality were nearly equal in our database. A large study comparing hospital mortality, 30-day mortality and operative mortality rates in CABG reported similarly . The authors concluded that because the numbers are nearly identical, the more convenient outcome in-hospital mortality could be used for outcomes evaluation. However, although the in-hospital and the 30-day mortalities are equivalent in numbers, they do not refer to the same patients: 20% of the patients counted in each measure are not included in the other measure. This difference is relevant because patients who die within 30 days are likely to be different from those who remain in the hospital for a long time and eventually die. The latter type of mortality is more likely to be influenced by preoperative comorbidities than the former . Thus, in-hospital mortality and 30-day mortality measure two different types of end points and are not interchangeable.
What Are Stat Categories
STAT categories classify heart surgeries into groups based on how risky or complex they are. The STAT 1 category indicates surgeries with the lowest risk of death, while the STAT 5 category indicates the surgeries with the highest risk of death. A hospital that has a high survival rate for STAT 5 cases indicates success at handling unpredictable situations during the operation and during recovery.
What we measure:
STAT 5 neonatal survival measures the percentage of babies with the most complex heart defects who survive their surgery and have been discharged from the hospital.
What it means:
At Childrens Colorado, our surgical team specializes in some of the most complex cardiovascular procedures, with special expertise in surgical repair during the newborn period. Having a high STAT 5 survival rate means that the newborn babies we treat are more likely to survive their operation than the national average, even though we accept many more complex patients.
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What Is Bypass Surgery
Coronary artery bypass graft surgery or bypass surgery is heart surgery that reroutes blood around obstructed arteries to enhance blood flow and oxygen to the heart.
- A graft vein or artery is extracted from a healthy blood vessel in the body during bypass surgery. After that, the graft is surgically implanted to bypass the obstruction or blockage in the occluded or poorly performing artery.
- Following surgery, blood will flow via the graft vessel, bypassing the blocked channel and delivering oxygen and nutrients to the tissue beyond the obstruction.
The most common reason for bypass surgery is to avoid or circumvent a blockage by a clot or plaque in a coronary artery due to atherosclerosis. If the blockage is not removed, the heart muscle beyond the obstruction is deprived of oxygen and nutrients, resulting in cardiac damage.
Benchmarking Using Different Outcome Measures
The effect of using different outcome measures on the benchmarking procedure is shown in Fig. . When in-hospital mortality is used as outcome, one low mortality outlier and two high mortality outliers are found . However, by using 30-day mortality as outcome measure, two other centres are identified as outliers as well: Centre B as a low mortality outlier and Centre E as a high mortality outlier. Prolonging follow-up from 30 days to 1 year leads to changes in outlier status in four hospitals . When the same is done for a subset of isolated CABG procedures, benchmarking results remain unchanged with the different follow-up periods. This is shown in Fig. .
Benchmarking of isolated CABG in 10 hospitals using different mortality measures. Interventions from 2007 until 2010 were included. Benchmarking results are unaffected by the choice of the follow-up period.
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Are There Alternatives To Standard Open
Thanks to medical advancements, many procedures that once required opening the chest can now take place using minimally invasive heart surgery or with small incisions. The surgeon sometimes still needs to cut through part of the breastbone .
Depending on your situation, your surgeon may be able to use these methods:
- Catheter-based: Your surgeon threads a catheter to the heart. The surgeon then inserts surgical instruments, balloons, or stents through the catheter to perform a procedure. Catheter-based procedures include transcatheter aortic valve replacement and coronary angioplasty and stenting.
- Video-assisted thoracic surgery : Your surgeon performs VATS by inserting a tiny video camera and surgical instruments into several small chest incisions. Your surgeon may use VATS to place a pacemaker, repair heart valves or treat an arrhythmia.
- Robotically-assisted: Certain patients with valvular heart disease, cardiac tumors, atrial fibrillation and septal defects may be candidates for this minimally invasive approach.
What Happens After Open
Two or three tubes will be in your chest when you wake up after surgery. These are to help drain fluid from the area around your heart. Intravenous lines may be inserted into your arm to deliver fluids, and a catheter may be inserted into your bladder to evacuate urine. Youll also be connected to equipment that tracks your heart rate. Nurses are available to support you if the need arises.Your first night is usually spent in the intensive care unit . For the next three to seven days, you will be relocated to a standard care room.
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How To Prepare For Open
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
Its important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.
Open Heart Surgery Survival Rates
Heart surgery programs typically report their overall survival rate as well as survival rates based on the complexity of the surgery.
What we measure:
The percentage of heart surgery patients who survive their open heart surgery.
At Childrens Colorado, our overall survival rate for all cardiac surgery patients, regardless of how complex the surgeries are, is 97.2%. This is the same as the national average.
What it means:
Having a higher survival rate indicates that a pediatric heart center is more experienced and better equipped for congenital heart surgery, and that fewer patients pass away during or after surgery.
Some heart centers take more complicated cases than others, which is why its important to also compare survival rates by complexity and type of defect.
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How Often Is Sts Data Updated
Childrens Colorado and other centers submit data to the STS twice per year. The STS then verifies the data and generates reports that allow us to compare our results with our peers.
We publish our outcomes data on this website as soon as possible following the STS data release, also twice per year.
Australian Heart Attack Survival Among Best In World But Could Be Better
Researchers have praised healthcare systems in Australia and New Zealand, after both nations recorded some of the worlds best long-term recovery rates for heart attack sufferers.
University of Queensland and Prince Charles Hospital cardiologist Associate Professor Isuru Ranasinghe and UQ Faculty of Medicines Dr Linh Ngo contributed to a study which found 62.3 per cent of heart attack sufferers in these nations lived a further seven years or more.
The survival rates we reported exceed those in the United States and England and are in the realm of Sweden, which had the best reported seven-year survival rate, Dr Ranasinghe said.From the 239,402 admissions with acute myocardial infarction , we found the survival rate in Australian and New Zealand hospitals was 76.2 per cent after three years, 68.6 per cent after five years, and 62.3 per cent at seven years.In particular, the prognosis for patients aged under 65 was excellent, with survival rates after seven years exceeding 85 per cent.Improved, evidence-based care is likely to explain these high survival rates, with secondary preventative measures such as targeted medicines increasing substantially since the year 2000.”In the years 1999 and 2016, the frequency of urgent cardiac stenting rose from 43 to 71 per cent of cases for patients with segment elevation myocardial infarction with a similar increase observed in New Zealand.”
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When Do You Need Heart Valve Replacement Surgery
A heart valve disease develops when the valve becomes either stiff, narrow , or leaky . These two disease states of the valve disrupt the flow of blood in and out of the heart.
Heart valve diseases can be present by birth or occur as a complication of other health conditions, such as rheumatic heart disease.
Many people who have heart valve disease may never experience any symptoms. Sometimes, the valve disease is diagnosed when a woman is pregnant. Doctors may still recommend heart valve replacement surgery to prevent the worsening of the heart condition.
With a diseased valve, heart valve replacement surgery becomes an emergency if you experience:
Number Of Heart Surgeries Performed At Childrens Colorado
What we measure:
Surgical volume indicates the number of heart surgeries performed at a hospital.
Cardiopulmonary bypass indicates when a patient has to be connected to a machine that does the work of the heart and lungs while surgeons repair the heart. These surgeries are more complex than those without cardiopulmonary bypass.
Cardiac surgery volume
| 681 |
What it means:
Childrens Colorado is a high-volume cardiac surgery center, performing more than 500 surgeries each year for patients with congenital heart disease. We also perform hundreds of surgeries with cardiopulmonary bypass each year. This means we have the team, the experience and the facilities to treat kids, teens and even adults with a wide variety of congenital heart defects.
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Who Is In Theater For Open Heart Surgery
A team of doctors and other health professionals work together in the operating theater during open heart surgery.
The team is likely to include:
- the lead surgeon who will direct others surgeons who will assist during the operation
- the anesthesiologist, who is in charge of giving and anesthesia and monitoring vital signs
- the pump team, also known as perfusionists, operate the heart-lung machine and other technical equipment that supports open heart surgery
- nurses and technicians, who assist the surgical team and prepare the operating theater for surgery
Recovery After Open Heart Surgery
Open heart surgery is a serious procedure that necessitates constant monitoring and post-operative care. After the procedure, a person may need to stay in the intensive care unit for a few days to receive further treatment. A breathing tube will be left in place for a while after the operation to help with breathing. In addition, a line is left in the vein to provide pain treatment. A person could be connected up to a variety of various monitoring devices. A person will most likely stay in the hospital for roughly a week after exiting ICU. After leaving the hospital, it normally takes 4 to 6 weeks to recover at home. Take your time and be patient. Returning to normal levels of activity can take weeks or months. As part of a specific cardiac rehabilitation programme, some doctors may provide specialist support for daily activities and other aspects of recovery. Blood tests, heart scans, and stress testing may be part of the aftercare for each patient. During a treadmill activity, the heart is monitored as part of a stress test.
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Risk Factor Analysis With Survival And Changes In Cardiac Symptoms And Lvef
Post op NYHA class 34 was the only factor associated with 10-year all-cause mortality with OR of 6.3 and P value =0.012. The mean survival of patients in post op NYHA class 34 was 89.7±11.7 months , versus 120.3±8.5 months in patients with NYHA class 12 symptoms . Improvement in LVEF 5% post CABG showed a tendency to improve 10-year survival, but the effect was not statistically significant . The presence of diabetes mellitus showed a trend towards worsened 10-year all cause survival , but the difference was not statistically significant . All patients with insulin dependent diabetes died at 10 years, but analysis was not possible as the at-risk population was only 4.
Figure 5
Post op NYHA class 34 was also associated with worsened 10 year cardiac-event related mortality, with mean cardiac-related event free survival of 99.3±11.8 months in the NYHA class 34 group & 135.7±6.6 months in the class 12 group .
Figure 6
Complete revascularization and presence of all viable segments was not associated with all cause or cardiac-event related mortality. Neither of the two factors had association with post op LVEF improvement or post op NYHA class.