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For babies with heart defects, death risk is far lower at most experienced hospitals
Date:12/17/2007

lethal if not treated within a few weeks of birth, with operations called the arterial switch operation for TGA and the Norwood procedure for HLHS. Infants may need additional operations later in life, but these initial open-heart procedures are critical for their survival.

The study shows that an infants risk of dying in the hospital during or after their operation varied greatly depending on the number of each procedure performed that year at the hospital where they were treated. Mortality rates ranged from more than 10 percent to less than 1 percent for the arterial switch operation, and from more than 35 percent to around 10 percent for the Norwood procedure.

The relationship between hospital volume and risk of dying was significant across the spectrum for both defects, though in the case of arterial switch operations the difference dwindled among hospitals that performed about 15 or more in a year, says Hirsch, a Lecturer in the Section of Cardiac Surgery at the U-M Medical School who performs operations at the U-M C.S. Mott Childrens Hospital. For the Norwood, the trend to decreased mortality did not level off.

The researchers chose the two conditions for their study not because the operations themselves vary in difficulty both require skilled surgeons and operating room teams but because of differences in the difficulty of pre- and post-surgical care. TGA care is considered somewhat less tricky than HLHS care. Even after the Norwood operation, babies with HLHS will still need at least two more operations in their first years of life to palliate their defect.

All of the surgeons who operate on congenital heart defects are incredibly well trained, says Hirsch, noting that pediatric cardiac surgeons must complete more than 10 years of surgical training after four years of college and four years of medical school to operate on the tiny hearts of infants and children. Its a matter of exposure to these complex cases not jus
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System  
Source:Eurekalert

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