Clinical scale for assessing the risks of complications in pediatric cardiac surgery patients

Abstract

Mortality-based comorbidity indices worldwide have had mixed success in adjusting for risk in children. Despite numerous attempts to predict perioperative mortality and complications after cardiac surgery in adults, an objective model for predicting risks in children has not been developed. The purpose of the study: to analyze the frequency and structure of comorbidities and conditions in children with cardiac surgical pathology in order to assess the perioperative risks of complications and implement their own prognostic risk scale. Materials and methods. A comprehensive analysis of five hundred cardiac surgery patients hospitalized in the Department of Cardiac Surgery for the period of 2017–2023 was carried out, and there was studied the autopsy material of 350 patients with congenital heart defects according to the pathoanatomical bureau. Patients underwent standard research methods: echocardiography, chest X-ray, neurosonography and abdominal ultrasound, clinical and laboratory studies, blood for IUI, for procalcitonin, immunogram, angiocardiography, CT and MRI according to indications, bacteriological studies of smears, plain radiography of the abdominal cavity in the standard positions, trepanobiopsy, and genetic studies according to indications. Results. A classification of common comorbidities in pediatric cardiac surgery patients is presented and a stratification scale of comorbidity is developed. A high incidence of comorbidity in cardiac surgery patients (70%) and its impact on preoperative and postoperative management, timing of surgery and the development of complications, and financial risks are shown. It is shown that, along with the Aristotle cardiac surgical scale, the surgical risk assessment based on comorbidity developed by us improves the awareness of patients’ parents about the prognosis and risks of heart and vascular surgery. Conclusion. Evaluation of the role of the coexistence of extracardiac congenital malformations, genetic anomalies and syndromes, metabolic diseases in cardiac surgical patients can significantly affect surgical and therapeutic strategies and outcomes. Early identification of children at high risk of complications and death through the use of different stratification scales can lead to improved treatment outcomes.