Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-20T01:53:06.829Z Has data issue: false hasContentIssue false
  • English
  • Français

A population-based study relevant to seasonal variations in causes of death in children undergoing surgery for congenital cardiac malformations

Published online by Cambridge University Press:  22 June 2007

Leif T. Eskedal ,
Petter S. Hagemo ,
Anne Eskild ,
Kathrine F. Frøslie ,
Stephen Seiler  and
Erik Thaulow
Leif T. Eskedal*
Affiliation:
Department of Paediatrics, Sørlandet Regional Hospital, Kristiansand, Norway
Petter S. Hagemo
Affiliation:
Section Paediatric Cardiology, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway
Anne Eskild
Affiliation:
Department of Obstetrics and Gynaecology, Akershus University Hospital, and Division of Mental Health, National Institute of Public Health, Oslo, Norway
Kathrine F. Frøslie
Affiliation:
Section of Biostatistics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway
Stephen Seiler
Affiliation:
Faculty of Health and Sport, Agder University College, Kristiansand, Norway
Erik Thaulow
Affiliation:
Section Paediatric Cardiology, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway
*
Correspondence to: L Eskedal, Department of Paediatrics, SSHF, service box 416, 4604 Kristiansand, Norway. Tel: +47 3807 4010; Fax: +47 3807 4041; E-mail: leif.eskedal@sshf.no
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims

Our objectives were, first, to study seasonal distribution of perioperative deaths within 30 days after surgery, and late death, in children undergoing surgery for congenitally malformed hearts, and second, to study the causes of late death.

Methods

We analysed a retrospective cohort of 1,753 children with congenital cardiac malformations born and undergoing surgery in the period from 1990 through 2002 with a special focus on the causes of late death. The data was obtained from the registry of congenital cardiac malformations at Rikshospitalet, Oslo, and the Norwegian Medical Birth Registry. The mean follow-up from birth was 8.1 years, with a range from zero to 15.2 years.

Results

During the period of follow-up, 204 (11.6%) of the children died having undergone previous surgery. Of these 124 (7.1%) died in the perioperative period, and 80 (4.5%) were late deaths. There were 56 late deaths during the 6 coldest months, compared with 24 during the 6 warmest months (p < 0.01). There was no significant seasonal variation in perioperative deaths. Respiratory infection was the most common cause of late death, and occurred in 25 children, of whom 24 died during the 6 coldest months. Of the 8 sudden late deaths, 7 occurred during the 6 coldest months. There was no seasonal variation for the other causes of death.

Conclusions

In children undergoing surgery for congenital cardiac malformations in Norway, there is a seasonal variation in late death, with a higher proportion occurring in the coldest months. Death related to respiratory infections predominantly occurs in the winter season, and is the overall most common cause of late death.

Keywords

Mortalityrespiratory infectionrespiratory syncytial virussudden deathDown's syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 423 - 431
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Grech, V, Elliott, MJ. Evolution of surgical trends in congenital heart disease: a population based study. Int J Cardiol 1998; 66: 285–292.CrossRefGoogle ScholarPubMed
2. Lundstrom, NR, Berggren, H, Bjorkhem, G, Jogi, P, Sunnegardh, J. Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 2000; 21: 353–357.CrossRefGoogle ScholarPubMed
3. Eskedal, L, Hagemo, PS, Eskild, A, Aamodt, G, Seiler, KS, Thaulow, E. Survival after surgery for congenital heart defects: does reduced early mortality predict improved long-term survival? Acta Paediatr 2005; 94: 438–443.CrossRefGoogle ScholarPubMed
4. Stark, J, Gallivan, S, Lovegrove, J, et al. . Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 2000; 355: 1004–1007.CrossRefGoogle ScholarPubMed
5. Frid, C, Bjorkhem, G, Jonzon, A, Sunnegardh, J, Anneren, G, Lundell, B. Long-term survival in children with atrioventricular septal defect and common atrioventricular valvar orifice in Sweden. Cardiol Young 2004; 14: 24–31.CrossRefGoogle ScholarPubMed
6. Moller, JH, Powell, CB, Joransen, JA, Borbas, C. The pediatric cardiac care consortium--revisited. Jt Comm J Qual.Improv 1994; 20: 661–668.Google ScholarPubMed
7. Jenkins, KJ, Gauvreau, K. Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124: 97–104.CrossRefGoogle ScholarPubMed
8. Lacour-Gayet, F, Clarke, DR. The Aristotle method: a new concept to evaluate quality of care based on complexity. Curr Opin Pediatr 2005; 17: 412–417.CrossRefGoogle Scholar
9. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. . The Aristotle score for congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 185–191.CrossRefGoogle ScholarPubMed
10. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. . The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.CrossRefGoogle Scholar
11. Stark, JF, Gallivan, S, Davis, K, et al. . Assessment of mortality rates for congenital heart defects and surgeons' performance. Ann Thorac Surg 2001; 72: 169–174.CrossRefGoogle ScholarPubMed
12. Gibbs, JL, Monro, JL, Cunningham, D, Rickards, A. Survival after surgery or therapeutic catheterisation for congenital heart disease in children in the United Kingdom: analysis of the central cardiac audit database for 2000-1. BMJ 2004; 328: 611.CrossRefGoogle ScholarPubMed
13. Nieminen, HP, Jokinen, EV, Sairanen, HI. Late results of pediatric cardiac surgery in Finland: a population-based study with 96% follow-up. Circulation 2001; 104: 570–575.CrossRefGoogle ScholarPubMed
14. Morris, CD, Menashe, VD. 25-year mortality after surgical repair of congenital heart defect in childhood. A population-based cohort study. JAMA 1991; 266: 3447–3452.CrossRefGoogle ScholarPubMed
15. Oechslin, EN, Harrison, DA, Connelly, MS, Webb, GD, Siu, SC. Mode of death in adults with congenital heart disease. Am J Cardiol 2000; 86: 1111–1116.CrossRefGoogle ScholarPubMed
16. Silka, MJ, Hardy, BG, Menashe, VD, Morris, CD. A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 1998; 32: 245–251.CrossRefGoogle ScholarPubMed
17. Nollert, G, Fischlein, T, Bouterwek, S, Bohmer, C, Klinner, W, Reichart, B. Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997; 30: 1374–1383.CrossRefGoogle ScholarPubMed
18. Fenton, KN, Siewers, RD, Rebovich, B, Pigula, FA. Interim mortality in infants with systemic-to-pulmonary artery shunts. Ann Thorac Surg 2003; 76: 152–156.CrossRefGoogle ScholarPubMed
19. Keane, JF, Driscoll, DJ, Gersony, WM, et al. . Second natural history study of congenital heart defects. Results of treatment of patients with aortic valvar stenosis. Circulation 1993; 87: I16–I27.Google ScholarPubMed
20. Young, D, Mark, H. Fate of the patient with the Eisenmenger syndrome. Am J Cardiol 1971; 28: 658–669.CrossRefGoogle ScholarPubMed
21. Kopf, GS, Mello, DM. Surgery for congenital heart disease in low-birth weight neonates: a comprehensive statewide Connecticut program to improve outcomes. Conn Med 2003; 67: 327–332.Google ScholarPubMed
22. Van Mierop, LH. Diagnostic code for congenital heart disease. Pediatr Cardiol 1984; 5: 331–362.CrossRefGoogle ScholarPubMed
23. Van Mierop, LH. Diagnostic code for congenital heart disease, supplement. Pediatr Cardiol 1986; 7: 31–34.CrossRefGoogle Scholar
24. Pradat, P, Francannet, C, Harris, JA, Robert, E. The epidemiology of cardiovascular defects, part I: a study based on data from three large registries of congenital malformations. Pediatr Cardiol 2003; 24: 195–221.CrossRefGoogle Scholar
25. Harris, JA, Francannet, C, Pradat, P, Robert, E. The epidemiology of cardiovascular defects, part 2: a study based on data from three large registries of congenital malformations. Pediatr Cardiol 2003; 24: 222–235.CrossRefGoogle ScholarPubMed
26. Fleming, DM, Cross, KW, Pannell, RS. Influenza and its relationship to circulatory disorders. Epidemiol Infect 2005; 133: 255–262.CrossRefGoogle ScholarPubMed
27. Meyers, DG. Could influenza vaccination prevent myocardial infarction, stroke and sudden cardiac death? Am J Cardiovasc Drugs 2003; 3: 241–244.CrossRefGoogle ScholarPubMed
28. Moler, FW, Khan, AS, Meliones, JN, Custer, JR, Palmisano, J, Shope, TC. Respiratory syncytial virus morbidity and mortality estimates in congenital heart disease patients: a recent experience. Crit Care Med 1992; 20: 1406–1413.CrossRefGoogle ScholarPubMed
29. MacDonald, NE, Hall, CB, Suffin, SC, Alexson, C, Harris, PJ, Manning, JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 1982; 307: 397–400.CrossRefGoogle ScholarPubMed
30. Fleming, DM, Pannell, RS, Cross, KW. Mortality in children from influenza and respiratory syncytial virus. J Epidemiol Community Health 2005; 59: 586–590.CrossRefGoogle ScholarPubMed
31. Anderson, LJ, Parker, RA, Strikas, RL. Association between respiratory syncytial virus outbreaks and lower respiratory tract deaths of infants and young children. J Infect Dis 1990; 161: 640–646.CrossRefGoogle ScholarPubMed
32. Leader, S, Kohlhase, K. Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. J Pediatr 2003; 143: S127–S132.CrossRefGoogle ScholarPubMed
33. Bonnet, D, Schmaltz, AA, Feltes, TF. Infection by the respiratory syncytial virus in infants and young children at high risk. Cardiol Young 2005; 15: 256–265.CrossRefGoogle Scholar
34. Cabalka, AK. Physiologic risk factors for respiratory viral infections and immunoprophylaxis for respiratory syncytial virus in young children with congenital heart disease. Pediatr Infect Dis J 2004; 23: S41–S45.CrossRefGoogle ScholarPubMed
35. Saji, T, Nakazawa, M, Harada, K. Safety and efficacy of palivizumab prophylaxis in children with congenital heart disease. Pediatr Int 2005; 47: 397–403.CrossRefGoogle ScholarPubMed
36. Tulloh, RM, Feltes, TF. The European Forum for Clinical Management: prophylaxis against the respiratory syncytial virus in infants and young children with congenital cardiac disease. Cardiol Young 2005; 15: 274–278.CrossRefGoogle ScholarPubMed
37. Rackham, OJ, Thorburn, K, Kerr, SJ. The potential impact of prophylaxis against bronchiolitis due to the respiratory syncytial virus in children with congenital cardiac malformations. Cardiol Young 2005; 15: 251–255.CrossRefGoogle Scholar
38. Wegner, S, Vann, JJ, Liu, G, et al. . Direct cost analyses of palivizumab treatment in a cohort of at-risk children: evidence from the North Carolina Medicaid Program. Pediatrics 2004; 114: 1612–1619.CrossRefGoogle Scholar
39. Yount, LE, Mahle, WT. Economic analysis of palivizumab in infants with congenital heart disease. Pediatrics 2004; 114: 1606–1611.CrossRefGoogle ScholarPubMed
40. Feltes, TF, Cabalka, AK, Meissner, HC, et al. . Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003; 143: 532–540.CrossRefGoogle ScholarPubMed
41. Pelech, AN, Neish, SR. Sudden death in congenital heart disease. Pediatr Clin North Am 2004; 51: 1257–1271.CrossRefGoogle ScholarPubMed
42. Straus, SM, Bleumink, GS, Dieleman, JP, van der, LJ, Stricker, BH, Sturkenboom, MC. The incidence of sudden cardiac death in the general population. J Clin Epidemiol 2004; 57: 98–102.CrossRefGoogle ScholarPubMed
43. Messner, T, Lundberg, V. Trends in sudden cardiac death in the northern Sweden MONICA area 1985-99. J Intern Med 2003; 253: 320–328.CrossRefGoogle ScholarPubMed
44. Arntz, HR, Willich, SN, Schreiber, C, Bruggemann, T, Stern, R, Schultheiss, HP. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. Eur Heart J 2000; 21: 315–320.CrossRefGoogle Scholar
45. Eskedal, L, Hagemo, P, Eskild, A, Aamodt, G, Seiler, KS, Thaulow, E. A population-based study of extra-cardiac anomalies in children with congenital cardiac malformations. Cardiol Young 2004; 14: 600–607.CrossRefGoogle ScholarPubMed
46. Yang, Q, Rasmussen, SA, Friedman, JM. Mortality associated with Down's syndrome in the USA from 1983 to 1997: a population-based study. Lancet 2002; 359: 1019–1025.CrossRefGoogle ScholarPubMed
47. Mikkelsen, M, Poulsen, H, Nielsen, KG. Incidence, survival, and mortality in Down syndrome in Denmark. Am J Med Genet Suppl 1990; 7: 75–78.Google ScholarPubMed