Intraoperative Cardiac Events in Pediatric Patients with Congenital Heart Disease Undergoing Noncardiac Procedures: Analysis of a Large Multicenter Registry

Authors

Viviane G. Nasr, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Michael Kuntz, Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Vannessa Chin, The Hospital for Sick Children, Department of Anesthesiology and Pain Medicine, Toronto, Ontario, Canada.
Nina Deutsch, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
David Faraoni, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Wanda C. Miller-Hance, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Susan C. Nicolson, Division of Cardiothoracic Anesthesia, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Martina Richtsfeld, Department of Anesthesiology, Division of Pediatric Cardiac Anesthesia, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
Steven J. Staffa, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Document Type

Journal Article

Publication Date

10-3-2025

Journal

Anesthesiology

DOI

10.1097/ALN.0000000000005783

Abstract

INTRODUCTION: Patients with congenital heart disease (CHD) remain at high risk for morbidity and mortality when undergoing noncardiac procedures. Existing studies have utilized national databases focusing on mortality or are limited by small data sets from single institutions. Through a multi-institutional registry study, the primary aim is to describe the incidence of intraoperative cardiac events in patients with CHD undergoing noncardiac procedures. The secondary aim is to describe the risk factors associated with the events. METHODS: Patients with CHD from birth to 21 years undergoing noncardiac procedures between January and December 2021, were identified at all participating centers. The primary outcome was occurrence of an intraoperative cardiac event at each encounter, defined as the composite of intraoperative hemodynamic instability, cardiac arrest, and pulmonary hypertensive crisis. RESULTS: The final analysis involved 4,343 unique patients at 7 centers undergoing 6455 procedures. Among the cohort, 335 of 6455 procedures involved an intraoperative cardiac event (5.2%) in 296 unique patients. The most common event was hypotension (n=315, 4.9%); there were 12 occurrences of cardiac arrest (0.2%). Univariate analysis showed multiple factors associated with the increased likelihood of an intraoperative cardiac events including patient and procedure characteristics, cardiac disease, and anesthetic management. Examples of patient characteristics include prematurity (OR1.34,95%CI 1.02-1.76, P=0.038), chronic medical conditions (gastrointestinal (OR1.51, 95%CI 1.15-1.99,P=0.003), respiratory (OR2.12, 95%CI 1.62,2.76,P<0.001)), preoperative ventilatory support (OR3.88, 95%CI2.8,5.38, P<0.001), concurrent respiratory illness (OR 2.18, 95% CI 1.47,3.2, P<0.001), major cardiac disease (OR2.09, 95%CI 1.54,2.83, P<0.001), and severe CHD (OR3.48, 95%CI 2.47,4.91, P<0.001). DISCUSSION: Pediatric patients with severe CHD, those undergoing emergency procedures, and those undergoing surgical interventions were at higher risk of not only mortality as shown previously, but also hemodynamic instability. These are established risk factors for intraoperative cardiac events and should be considered when planning risk mitigation strategies.

APA Citation

Nasr, Viviane G.; Kuntz, Michael; Chin, Vannessa; Deutsch, Nina; Faraoni, David; Miller-Hance, Wanda C.; Nicolson, Susan C.; Richtsfeld, Martina; and Staffa, Steven J., "Intraoperative Cardiac Events in Pediatric Patients with Congenital Heart Disease Undergoing Noncardiac Procedures: Analysis of a Large Multicenter Registry" (2025). GW Authored Works. Paper 8318.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8318

Department

Anesthesiology and Critical Care Medicine