Kritik Konjenital Kalp Hastalıklı Yenidoğanlarda Kardiyak Girişim Sonrası Mortaliteyi Etkileyen Ana Risk Faktörleri

Objective: It was aimed to define the main risk factors that affect mortality in infants with critical congenital heart disease (CHD). Material and Methods: We analyzed data from 105 infants with critical CHD underwent cardiovascular intervention at a tertiary neonatal intensive care unit (NICU) between September 2010 and January 2012. Demographic data, clinical findings (before and after intervention), type of intervention, and intervention risk score according to Risk Adjustment in Congenital Heart Surgery (RACHS-1) classification were evaluated. Results: The mean age at cardiovascular intervention was 15.2±11.8 days. Transcatheter interventions were performed in 29 patients (27.6%). Seventy-six patients (72.4%) underwent cardiovascular surgery. At post-interventional period, the rates of low cardiac output, pneumonia, and sepsis were significantly higher among patients underwent surgical intervention. Length of NICU stay was also longer among them. Overall mortality rate was 35.2% (n=37). Mortality was significantly lower in infants underwent transcatheter intervention. Univariate analyses showed that nonsurvivors differed from survivors in terms of gestational age, prematurity, the presence of associated disorder, pre-interventional need of mechanical ventilation, need of inotropic support, the presence of pulmonary hypertension and sepsis, requirement of cardiovascular surgery, age at intervention, and RACHS-1 score. Multivariate analysis showed that higher RACHS-1 score was associated with mortality (OR: 4.5, 95% CI (1.5-13.1), p=0.005) while higher gestational age was a preventive factor (OR: 0.6, 95% CI (0.5-0.9), p=0.01). Conclusion: Our study indicates that lower gestational age and severity of the disease seem to be most possible risk factors for mortality among infants with critical CHD.