Link: https://www.ncbi.nlm.nih.gov/pubmed/30267752

Semin Thorac Cardiovasc Surg. 2018 Sep 26. pii: S1043-0679(130287-9. doi: 10.1053/j.semtcvs.2018.09.014. [Epub ahead of print]
The Prevalence and Impact of Congenital Diaphragmatic Hernia among Patients Undergoing Surgery for Congenital Heart Disease.
Fraser CD 3rd1, Hill KD2, Wallace A2, Chiswell K2, Zhou X1, Jelin EB3, Kays D4, Jacobs JP5, Hibino N1, Jacobs ML1, Vricella LA6.
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Abstract
OBJECTIVE:
There has not been a multicenter investigation to elucidate the prevalence and impact of congenital diaphragmatic hernia (CDH) on children undergoing cardiac surgery. We investigated the prevalence of CDH across congenital cardiac diagnostic and procedural groups and its impact on outcomes.

METHODS:
The STS Congenital Heart Surgery Database was queried to identify children undergoing cardiac surgery who also had CDH. Baseline perioperative characteristics and postoperative outcomes were compared between groups. Subgroup analyses were performed based on case complexity as determined by STAT Categories.

RESULTS:
Overall 426/157,419 (0.27%) pediatric patients undergoing an index cardiac operation had a diagnosis of CDH including 89 neonates (0.25% of all neonatal index operations), 217 infants (0.39%) and 120 children (0.18%). The frequency of concomitant CDH varied across diagnostic groups and, in neonates and infants, was highest for tetralogy of Fallot (0.45%, n=41), coarctation (0.39%, n =27) and complete atrioventricular septal defects (0.31%, n=19). For neonates and infants outcomes were generally worse in CDH vs. no-CDH patients across the various procedural strata. For example, STAT ≥ 3 operative mortality was 34.4% vs 10.3% (p<0.001) for neonates, and 24.2% vs 5.3% (p<0.001) for infants with vs without CDH, respectively. In older children, outcomes disparities were less clear cut with no significant differences in mortality, and variable differences for complication and length of stay outcomes.

CONCLUSIONS:
CDH occurs in a small percentage of patients born with congenital heart disease. Concomitant diagnosis of CDH portends increased morbidity and mortality in infants and neonates undergoing cardiac surgery.

Copyright © 2018. Published by Elsevier Inc.

KEYWORDS:
CDH, Congenital Diaphragmatic Hernia DCRI - Duke Clinical Research Institute PDA, Patent Ductus Arteriosus PLOS, Postoperative Length of Stay STS-CHSD - Society of Thoracic Surgeons Congenital Heart Surgery Database VSD, Ventricular Septal Defect; Glossary of Abbreviations: AVSD, Atrioventricular septal defect

PMID: 30267752 DOI: 10.1053/j.semtcvs.2018.09.014
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