Surgical and postoperative management of congenital heart disease: a systematic review of observational studies.

Abstract

Background: Congenital heart disease (CHD) remains a critical concern in pediatric and adult cardiovascular care, requiring continuous advancements in surgical techniques and perioperative strategies. While survival rates have improved, challenges persist in optimizing long-term neurodevelopmental outcomes, addressing disparities in healthcare access, and overcoming systemic barriers to implementing best practices. This systematic review integrates recent evidence on predictive factors, perioperative innovations, and economic challenges affecting CHD management.

Methods: A systematic review was conducted, analyzing data from 27 observational studies, including retrospective and prospective cohort studies, as well as case reports, sourced from diverse geographic and clinical settings. Studies were selected based on strict inclusion criteria, emphasizing clear surgical outcomes, perioperative advancements, and neurodevelopmental follow-up. Data were extracted and synthesized to identify key trends in CHD surgery, anesthetic management, and long-term patient care.

Results: Key findings include: • Neurodevelopmental Outcomes: Long-term follow-up studies identified associations between prolonged ICU stays, intraoperative cerebral oxygenation deficits, and developmental delays. Hearing loss was reported in 21.6% of post-surgical patients, significantly impacting cognitive and language abilities. • Predictive Factors for Postoperative Outcomes: Hemoglobin saturation, lactate levels, and platelet counts were statistically associated with adverse postoperative outcomes (p < 0.05), reinforcing the need for preoperative risk stratification. • Fast-Track Extubation and Resource Optimization: Early extubation protocols reduced ICU stays by an average of 20%, with a 15% decrease in postoperative complications. However, financial disincentives and inadequate reimbursement models limited their widespread adoption, particularly in low-resource settings. • Tailored Anesthetic Techniques: Individualized anesthesia strategies, including neuroprotective approaches and blood conservation techniques, improved outcomes in high-risk CHD populations, reducing complication rates by up to 10%. • Global Disparities in CHD Care: Studies from low-income countries revealed significantly higher rates of malnutrition, delayed surgical interventions, and postoperative complications. These disparities highlight the urgent need for global policy reforms to improve healthcare equity in CHD management.

Conclusion: This review highlights the necessity of integrating predictive analytics, multidisciplinary approaches, and healthcare system reforms to enhance CHD management. While advancements in surgical techniques and perioperative care yield promising outcomes, persistent challenges-including healthcare disparities, financial constraints, and long-term neurodevelopmental risks-require targeted interventions. Future research should focus on personalized care models, global health policy adjustments, and innovative technologies to optimize CHD patient outcomes.