Assessment the Accuracy of Risk Adjustment in Congenital Heart Surgery Score in Congenital Cardiac Centers at Dakahlya Government

Abstract

Background: There has been massive progress in congenital cardiac surgery outcomes analysis in the last two decades. The RACHS-1 score was developed to adjust for the huge difference in congenital cardiac pathologies when comparing the operative mortality for children undergoing paediatric congenital heart surgery. Methods: This prospective observational study was conducted on all patients undergoing cardiac surgery in all congenital heart surgery centers in Dakahlya Governorate, where we assessed the operative mortality post-surgery and compared it to the RACHS-1 expected mortality to assess the accuracy of using the RACHS-1 to predict mortality in our society. Results: This study included 559 patients in two years period, VSD was the most frequent diagnosis (13.6%), followed by Single ventricle (11.3%), then TOF (10.4%). VSD closure was the most frequent procedure (11.3%), followed by mB-T shunt (8.9%), then TOF repair (8.1%). Day-30 outcome among the studied cases Mortality was uncommon (7.9%), the main cause was heart in aetiology (43.2%). Mortality was significantly highest in HLHS, and then followed by TAPVD. The overall mortality according to each category was 1.2%, 3%, 8.57%, 17.39%, 0% and 57.1% for category 1, 2, 3, 4, 5 and 6. Conclusion: RACHS-1 is an accurate method to predict mortality early post operatively. Ventricular septal defect (VSD) was the most frequent diagnosis. VSD closure was the most frequent procedure, followed by mB-T shunt, then TOF repair, most of them were elective. The most common category of RACHS-1 was 3. HLHS, RACHS≥3, Palliation operation were significant independent factors increase the day-30 mortality.