R. Ukrani1, R. Martins2, M. Memon3, S. Akhtar4 1Aga Khan University Medical College, Medical School, Karachi, Sindh, Pakistan 2Hackensack Meridian Health Network, Department Of Surgery, Edison, NEW JERSEY, USA 3Liaquat National Hospital & Medical College, Department Of Pediatrics, Karachi, SINDH, Pakistan 4Aga Khan University Medical College, Department Of Pediatrics, Karachi, Sindh, Pakistan
Introduction: While adult congenital heart disease (ACHD) surgery in the developed world mostly entails reoperations for previous repairs, the majority of ACHD operations in developing countries are performed on patients surviving into adulthood with hitherto unrepaired defects. Longer aortic cross-clamp (XCT) times during these high-risk operations may lead to worse postoperative outcomes and also pose a significant resource drain to hospitals in developing countries.
In this study, the first of its kind, we aimed to identify risk factors and outcomes of prolonged aortic cross-clamp time (PXCT) in patients undergoing operations for adult congenital heart disease (ACHD) in Pakistan.
Methods: This retrospective study included all consecutive adult patients (?18 years) who underwent cardiac surgery with cardiopulmonary bypass for their congenital heart defect at a tertiary-care hospital in Pakistan over a six-year period.Aortic cross-clamp time >80 minutes (60th percentile) was defined as prolonged XCT.
Results: Our study included 166 patients (53.6% males), with 65 (39.2%) patients categorized as having PXCT. Among 166 patients, the mean age was 32 years and comorbid conditions were present in 59% of patients. The most common surgery performed was atrial septal defect repair (42.2%). Postoperatively, complications occurred in 38.6% patients, with a higher incidence of pneumonia and acute kidney injury in the PXCT group.
Multivariable logistic regression analysis identified intraoperative transfusion, postoperative cardiovascular complications, longer ICU stay, and prolonged hospital stay to be associated with PXCT. Obesity was found to be protective against PXCT.
Conclusion: Prolonged XCT is significantly associated with postoperative cardiovascular complications, and longer ICU and hospital stay in patients undergoing operations for ACHD. In addition, obesity may confer a lower risk for prolonged XCT. These considerations are important, especially in resource-constrained developing countries like Pakistan.