Factors Associated with Complications and in-Hospital Mortality among Patients with Congenital Heart Disease Evacuated from Gabon for Cardiac Surgery

Q: What are the key findings of this study?

Respiratory distress independently predicted peri-operative complications in congenital heart disease patients evacuated from Gabon.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Congenital heart disease requiring surgical evacuation (n=72). Intervention: Pre-operative respiratory distress vs. Absence of respiratory distress. Primary outcome: Peri-operative complications (Adjusted OR 16.42, 95% CI 3.46-78.00, p=<0.001).

Q: What does this research mean for the field?

Respiratory distress and pre-operative cardiac failure are independent predictors of surgical complications in patients evacuated for congenital heart disease repair, with mortality restricted to infants. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify clinical and biological factors independently associated with postoperative complications and in-hospital mortality among patients with congenital heart disease evacuated abroad for cardiac surgery.

Ndoume Obiang F; Akagha Konde C; Yekini C; Mpori J; Kinga A; Tessa G; Mipinda JB; Allognon C; Ayo Bivigou E

doi:10.33425/2639-944x.1473

May 31, 2026Journal of Medical - Clinical Research & ReviewsOpen Access

Factors Associated with Complications and in-Hospital Mortality among Patients with Congenital Heart Disease Evacuated from Gabon for Cardiac Surgery

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Key result

Preoperative respiratory distress is linked to ~16.4-fold higher odds of perioperative complications in congenital heart disease.

Adjusted OR 16.42
95% CI 3.46-78.00
P<0.001
n=72

Why the study?

Congenital heart disease in Gabon requires surgical evacuation abroad due to the absence of local cardiac surgery, and the clinical and biological factors independently associated with complications and in-hospital mortality in this population needed to be identified.

Key Points

To identify clinical and biological factors independently associated with postoperative complications and in-hospital mortality among patients with congenital heart disease evacuated abroad for cardiac surgery.
Retrospective multicentre analytical cohort study conducted from 2021 to 2023 including N = 72 patients with congenital heart disease evacuated from Gabon for cardiac surgery.
Evaluated primary endpoints of complications (n = 22/69; 31.9%) and in-hospital death (n = 11/70; 15.7%) using chi-square or Fisher's exact tests and binary logistic regression.
Multivariate logistic regression identified respiratory distress (adjusted OR 16.42; 95% CI 3.46-78.00; p < 0.001) and pre-operative cardiac failure (adjusted OR 4.99; 95% CI 1.43-17.40; p = 0.012) as independent predictors of complications.
All 11 in-hospital deaths occurred exclusively in infants aged ≤ 24 months (n = 11/40; 27.5% of infants vs. 0% in older age groups; p = 0.0008).
Univariate predictors of in-hospital mortality included respiratory distress (OR 9.26; p = 0.003), pulmonary atresia (OR 11.06; p = 0.023), fever (OR 11.06; p = 0.023), and oxygen desaturation (OR 5.37; p = 0.028).

Study Design

Type

Cohort (n=72)

Multicenter

Yes

Structured PICO

P

Population

72 patients (mean age 5.6 years, 52.8% female; 55.6% infants ≤24 months) with congenital heart disease evacuated from Gabon for cardiac surgery between 2021 and 2023, followed within 30 days of surgery.

E

Exposure

Medical evacuation for corrective cardiac surgery abroad (performed in 70 of 72 patients; 97.2%)

O

Outcome

Two binary primary outcomes assessed within 30 days of surgery or during the evacuation period: (1) occurrence of any peri-operative complication (composite of PAH crisis, cardiac failure, bronchopneumopathy, anoxic crisis, complete atrioventricular block requiring pacemaker, haemodynamic failure, acute renal failure, Eisenmenger syndrome, sepsis, tamponade, or other), and (2) in-hospital death.composite

Main Result

Odds Ratio: 16.42 (95% CI 3.46–78)

Absolute Event Rate: 76.9% vs 20.3%

p-value: p=<0.001

In Gabonese patients with congenital heart disease evacuated abroad for surgery, pre-operative respiratory distress and cardiac failure independently predict peri-operative complications, while in-hospital mortality occurs exclusively in infants ≤24 months, underscoring the need for pre-operative haemodynamic optimisation and local paediatric cardiac surgical capacity.

Limitations

Retrospective design with selection bias toward operable patients insured by CNAMGS
Small number of fatal events (n = 11) limited statistical power and precluded multivariate regression for mortality
Post-operative follow-up was restricted to the evacuation period, missing delayed mortality after repatriation
Absence of echocardiographic pulmonary vascular resistance measurements precluded formal haemodynamic classification of PAH severity
Retrospective design carries inherent selection bias, as only patients deemed operable and insured by CNAMGS were included, potentially underrepresenting the most severely ill
Modest number of fatal events (n = 11) limited statistical power and precluded multivariate logistic regression for mortality
Post-operative follow-up was restricted to the evacuation period, and delayed mortality after repatriation could not be captured

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Implication

Respiratory distress may flag high peri-operative risk in evacuated CHD patients; leaves open whether optimization improves outcomes in prospective studies.

Abstract

Background: Congenital heart disease (CHD) carries substantial morbidity and mortality in sub-Saharan Africa, where delayed diagnosis and the absence of local cardiac surgery compound adverse outcomes. In Gabon, patients requiring surgical repair must be evacuated abroad. This study aimed to identify clinical and biological factors independently associated with complications and in-hospital mortality in this population. Methods: Retrospective multicentre analytical cohort study (2021-2023), N = 72 CHD patients evacuated from Gabon for cardiac surgery. Complications (n = 22/69; 31.9%) and death (n = 11/70; 15.7%) were the primary outcomes. Univariate associations were assessed by chi-square or Fisher's exact test. Binary logistic regression identified independent predictors of complications (rule of ten events per variable). Results: On univariate analysis, significant predictors of complications included: cyanotic CHD (OR 3.09; 95% CI 1.09- 8.75; p = 0.031), pulmonary atresia (OR 10.89; p = 0.028), respiratory distress (OR 13.06; 3.10-54.97; p < 0.001), oxygen desaturation (OR 4.80; p = 0.003), pre-operative cardiac failure (OR 3.80; p = 0.011), and polycythaemia (OR 8.95; p = 0.002). VSD was protective (OR 0.17; p = 0.006). On multivariate analysis, independent predictors of complications were respiratory distress (adjusted OR 16.42; 3.46-78.00; p < 0.001) and pre-operative cardiac failure (adjusted OR 4.99; 1.43-17.40; p = 0.012). All 11 deaths occurred in infants (≤ 24 months); univariate predictors of mortality included respiratory distress (OR 9.26; p = 0.003), pulmonary atresia (OR 11.06; p = 0.023), fever (OR 11.06; p = 0.023), and oxygen desaturation (OR 5.37; p = 0.028). Conclusion: Respiratory distress and pre-operative cardiac failure independently predict complications in CHD patients evacuated from Gabon. In-hospital mortality is restricted to infants and is associated with markers of severe haemodynamic compromise. These findings support early referral, systematic pre-operative haemodynamic optimisation, and the urgent development of local paediatric cardiac surgical capacity.

Discussion

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Cite This Study

F et al. (2026) conducted a cohort in Congenital heart disease requiring surgical evacuation (n=72). Pre-operative respiratory distress vs. Absence of respiratory distress was evaluated on Peri-operative complications (Adjusted OR 16.42, 95% CI 3.46-78.00, p=<0.001). Respiratory distress independently predicted peri-operative complications in congenital heart disease patients evacuated from Gabon.

synapsesocial.com/papers/6af46da27bb3da179b850261 https://doi.org/10.33425/2639-944x.1473

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Factors Associated with Complications and in-Hospital Mortality among Patients with Congenital Heart Disease Evacuated from Gabon for Cardiac Surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Factors Associated with Complications and in-Hospital Mortality among Patients with Congenital Heart Disease Evacuated from Gabon for Cardiac Surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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