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Ann Thorac Surg 2007;83:606-612
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Adults Undergoing Cardiac Surgery at a Children’s Hospital: An Analysis of Perioperative Morbidity

^a Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
^b Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

Accepted for publication August 30, 2006.

^_* Address correspondence to Dr Rossano, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, 6621 Fannin MC 19345-C, Houston, TX 77030 (Email: jrossano{at}bcm.tmc.edu).

BACKGROUND: Limited data exist regarding the perioperative morbidity profile of adults who have cardiac operations at pediatric facilities.

METHODS: A retrospective review (January 2000 to December 2004) of patients (aged 18 years or older) who underwent cardiac surgery at our pediatric institution was performed.

RESULTS: There were 149 cardiac operations performed in 135 patients. There were 2 early deaths. There were 70 preoperative noncardiac morbidities in 49 patients (36%) and 140 preoperative cardiac morbidities in 78 patients (58%). Preoperative arrhythmia (n = 76) and moderate or greater ventricular systolic dysfunction (n = 24) were most common. There were 51 postoperative adverse noncardiac events in 32 patients (24%). Renal insufficiency (> 0.5 mg/dL baseline change; n = 8) was most common. There were 53 postoperative adverse cardiac events in 44 patients (33%). Ventricular tachycardia (n = 13) was most common. Risk factors for postoperative adverse noncardiac events included preoperative histories of New York Heart Association (NYHA) class III or greater (p < 0.001), seizure (p = 0.04), and psychiatric disorder (p = 0.002). Risk factors for postoperative adverse cardiac events included older patient age (p = 0.001), preoperative functional single ventricle (p = 0.006), NHYA class III or greater (p = 0.003), atrial fibrillation/flutter (p < 0.001), and ventricular tachycardia or fibrillation (p = 0.04).

CONCLUSIONS: Postoperative adverse events occur frequently when adults undergo cardiac operations at children’s hospitals. Older patient age, preoperative arrhythmias, and preoperative NHYA class are predictors of postoperative adverse cardiac events.

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