What is the clinical evidence from this study?

Study design: Cohort. Population: Critical congenital heart disease (n=715). Intervention: Prenatal diagnosis vs. Postnatal diagnosis. Primary outcome: Operative mortality (OR 1.92, 95% CI 1.20-3.08, p=0.007).

April 4, 2023Open Access

Impact of prenatal diagnosis of critical congenital heart disease on preoperative and postoperative outcomes

Key Result

Prenatal diagnosis of critical congenital heart disease was associated with higher operative mortality (OR 1.92) and worse short-term postoperative outcomes compared to postnatal diagnosis.

Study Design

Type

Cohort (n=715)

Multicenter

Yes

Structured PICO

Does antenatal diagnosis of critical congenital heart disease improve preoperative and postoperative outcomes in neonates requiring cardiothoracic surgery?

Population

715 neonates diagnosed with critical congenital heart disease requiring cardiothoracic surgery with or without cardiopulmonary bypass in the neonatal period (≤ 30 days of age).

Intervention

Antenatal (prenatal) diagnosis of critical congenital heart disease

Comparator

Postnatal diagnosis of critical congenital heart disease

Outcome

Mortality, including operative mortality (all deaths occurring during the hospitalization or after hospital discharge if within 30 days of the procedure) and 30-day postoperative mortalityhard clinical

Prenatal diagnosis of critical congenital heart disease is associated with a more optimized preoperative clinical status but paradoxically less favorable short-term postoperative outcomes, potentially due to unmeasured disease severity.

Main Result

Effect estimate: OR 1.92 (95% CI 1.20-3.08)

Absolute Event Rate: 15.5% vs 8.7%

p-value: p=0.007

Limitations

Retrospective design unable to account for detailed patient-specific factors such as local resources at birth center or proximity to specialized cardiac center.
Reliance on broad cardiac diagnosis codes that cannot account for nuances in cardiac anatomic and physiologic disease severity.
Small sample sizes within diagnostic subgroups limiting the ability to find statistically significant differences.

Abstract

Abstract Objective : The objective of this study was to assess the relationship of prenatal diagnosis of critical congenital heart disease (CHD) to preoperative and postoperative patient findings. Method : Retrospective analysis of neonates with critical CHD who underwent cardiothoracic surgery at one of four centers in North Carolina between 2008-2013. Surgical data collected by sites for submission to the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and the North Carolina CHD Lifespan Database were queried. Results : There were 715 patients with STS records; 566 linked to the NC CHD database. Patients with prenatal diagnosis had a lower incidence of preoperative risk factors, including need for mechanical ventilation and presence of shock. However, prenatally diagnosed patients had worse short-term outcomes, including higher operative mortality, higher incidence of select postoperative complications, and longer LOS. There was no difference in one-year mortality. Conclusion : Our findings are consistent with current literature which suggests that prenatal diagnosis of critical CHD is associated with a more optimized preoperative clinical status. However, we found that patients with prenatal diagnoses had less favorable postoperative outcomes. This needs to be investigated further, but may be secondary to patient-specific factors, such as CHD disease severity.

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