EC Paediatrics

Introduction: Congenital heart diseases are structural and functional malformations of the heart present at birth, affecting between 0.4% and 1.2% of live newborns. They are among the leading causes of neonatal and pediatric mortality in Mexico. Despite advances in surgical treatments, postoperative complications such as acute kidney injury and prolonged mechanical ventilation remain significant risk factors.
Materials and Methods: This was an observational, analytical, and retrospective study conducted at a tertiary care hospital between 2021 and 2023. Patients with complex congenital heart diseases, such as Tetralogy of Fallot, Aortic Coarctation, and Transposition of the Great Arteries, who underwent surgery with Cardiopulmonary Bypass (CPB) were included. Serum creatinine levels and the duration of phase III ventilation were analyzed to assess their correlation with morbidity and mortality.
Results: Significant correlations were found between acute kidney injury and ventilatory score with postoperative complications. It was demonstrated that patients with prolonged Cardiopulmonary Bypass (CPB) duration and aortic clamping have a higher likelihood of short-term complications, including acute kidney injury and prolonged mechanical ventilation. These factors often lead to extended hospital stays and, in some cases, death.
Discussion: Acute kidney injury and ventilatory score are important predictors of postoperative prognosis. The results of this study can be used to improve morbidity and mortality prediction and to optimize individualized patient management. Conclusion: This study demonstrates that monitoring renal function and mechanical ventilation is crucial in reducing morbidity and mortality in these patients. The use of these parameters as indicators to predict postoperative risk is recommended to improve prognosis and short- and long-term survival.
Keywords: Congenital Heart Disease; Creatinine; Mechanical Ventilation; Morbidity and Mortality

1. Mendieta Alcántara G., et al. “Incidencia de las cardiopatías congénitas y los factores asociados a la letalidad en niños nacidos en dos hospitales del Estado de México”. Gaceta Médica de México 149.6 (2013): 617-623.
2. Godfrey M., et al. “The incidence of congenital heart defects in very low birth weight and extremely low birth weight infants”. Israel Medical Association Journal 12.1 (2010): 36-38.
3. De Rubens-Figueroa J., et al. “Frequency of 4,544 children with congenital and acquired heart disease. Echocardiographic study” [Frecuencia de cardiopatías congénitas y adquiridas en 4,544 niños. Estudio basado en ecocardiografía]. Archivos de cardiologia de Mexico 91.4 (2021): 407-414.
4. Moreno Granado F., et al. “Epidemiología de las cardiopatías congénitas”. Protocolos diagnósticos y terapéuticos en Cardiología Pediátrica 2 (2010): 1-12.
5. Erdmenger Orellana JR., et al. “Guías para el Manejo Clínico de las Cardiopatías Congénitas Más Frecuentes”: 4-10.
6. Shen H., et al. “Deep phenotypic analysis for transposition of the great arteries and prognosis implication”. Journal of the American Heart Association 11.3 (2022): 1-11.
7. Santens B., et al. “Outcome of arterial switch operation for transposition of the great arteries: a 35-year follow-up study”. International Journal of Cardiology 316 (2020): 94-100.
8. González Vergara A. “Circulación Extracorpórea en el Paciente Neonato con Cardiopatía Congénita”. Revista Mexicana de Cardiología 12.2 (2004): 69-75.
9. Fuentes Mallozi DA and Guillermo Báez DO. “Epidemiology of cardiac surgery in a pediatric intensive care unit”. Acta Médica Grupo Ángeles 20.4 (2022): 301-308.
10. Blinder JJ., et al. “Congenital heart surgery in infants: Effects of acute kidney injury on outcomes”. Journal of Thoracic and Cardiovascular Surgery 143.2 (2012): 368-374.
11. Gómez Amado JC. “Cambios Cognoscitivos Asociados al Uso de Circulación Extracorpórea en Pacientes Pediátricos con Cardiopatías Congénitas de la Fundación Cardiovascular de Colombia” (2008): 32.
12. Benavidez OJ., et al. “Complications and risk factors for mortality during congenital heart surgery admissions”. Annals of Thoracic Surgery 84.1 (2007): 147-155.
13. Yuan SM. “Acute kidney injury after pediatric cardiac surgery”. Pediatrics and Neonatology 60.1 (2019): 3-11.
14. Agarwal HS., et al. “Postoperative complications and association with outcomes in pediatric cardiac surgery”. Journal of Thoracic and Cardiovascular Surgery 148.2 (2014): 609-616.e1.
15. Costello JM., et al. “Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the society of thoracic surgeons congenital heart surgery database”. Circulation 129 (2014): 2511-2517.
16. Blinder JJ., et al. “Acute kidney injury after pediatric cardiac surgery: a secondary analysis of the safe pediatric euglycemia after cardiac surgery trial”. Pediatric Critical Care Medicine 18.7 (2017): 638-646.
17. Santiago MJ., et al. “Evolución y factores de riesgo de mortalidad en niños sometidos a cirugía cardíaca que requieren técnicas de depuración extrarrenal continua”. Revista Española de Cardiología 65.9 (2012): 795-800.