Open Access

ARTICLE

Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Europe and China: An Analysis of the European Congenital Heart Surgeons Association Congenital Heart Surgery Database

by Claudia Herbst^1,*, Haibo Zhang², Renjie Hu², Jürgen Hörer³, Masamichi Ono³, Vladimiro Vida⁴, Tjark Ebels^5,6, Andrzej Kansy⁷, Jeffrey P. Jacobs⁸, Zdzislaw Tobota⁷, Bohdan Maruszewski⁷

1 Department of Surgery, Division of Cardiac Surgery and Pediatric Heart Center, Medical University Vienna, Vienna, Austria
2 Department of Pediatric Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
3 Department for Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division for Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
4 Pediatric and Cardiac Surgery Unit, Department of Cardio Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
5 Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands
6 Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
7 Pediatric Cardiothoracic Surgery, Children’s Memorial Health Institute, Warsaw, Poland
8 St. Petersburg, FL, USA

* Corresponding Author: Claudia Herbst. Email:

Congenital Heart Disease 2021, 16(1), 17-25. https://doi.org/10.32604/CHD.2021.012982

Received 21 July 2020; Accepted 23 September 2020; Issue published 23 December 2020

Abstract

Background: The European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) was founded in 1999 and is open for worldwide participation. The current dataset includes a large amount of surgical data from both Europe and China. The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD. Methods: We examined all European (125 centers, 58,261 operations) and Chinese (13 centers, 23,920 operations) data in the ECHSA-CHSD from 2006-2018. Operative mortality, postoperative length of stay, median patient age and weight were calculated for the ten benchmark operations for China and Europe, respectively. Results: Benchmark procedure distribution frequencies differed between Europe and China. In China, ventricular septal defect repair comprised approximately 70% of procedures, while Norwood operations comprised less than one percent of all procedures. Neonatal cardiac procedures were rare in China overall. For procedures in STAT mortality category 1, Chinese centers had lower operative mortality rates, while procedures in categories 3 and 5 mortality is lower in European centers. Operative mortality over the time period decreased from 3.89% to 1.64% for the whole cohort, with a sharper decline in China. This drop coincides with an increase of submitted procedures over this 13-year-period. Conclusion: Chinese centers had higher programmatic volume of congenital heart surgeries, while European centers have a more complex case mix. Palliation for patients with functionally univentricular heart was performed less commonly in China. These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.

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