Cost-Effectiveness of the Prenatal Detection of Congenital Heart Diseases: A Systematic Literature Review.

Background: Congenital heart disease is the most common congenital condition worldwide, with a prevalence of 80 cases per 10 000 live births. In addition to perinatal morbidity and mortality, it entails long-term consequences such as multiple surgeries, prolonged hospitalizations, lifelong cardiac follow-up, reduced quality of life, risk of heart failure, and premature mortality in adulthood. This significant health and economic burden on healthcare systems and families highlights the relevance of evaluating the cost-effectiveness of methods for early detection of this condition. Objective: To conduct a systematic literature review (SLR) to identify and analyze existing economic evaluations on prenatal detection of congenital heart diseases through ultrasound, focusing on the reported cost-effectiveness results and the methodological quality of the evaluated studies according to established criteria. Methods: An SLR of economic evaluations was conducted following PRISMA guidelines. A quantitative synthesis of key methodological components of each economic evaluation was performed. The incremental medical costs, effectiveness measures, and cost-effectiveness ratios reported in each study were compiled and compared. The methodological quality was assessed according to compliance with the 24 CHEERS criteria. Results: We found 785 articles, of which only 7 met all inclusion criteria. Most were cost-effectiveness analyses, with the most common outcome being number of cases detected. Screening with only 4-chamber views interpreted by general practitioners or cardiologists were dominant strategies compared with screening with 4-chamber plus outflow views interpreted by a general practitioner. Fetal echocardiography was most effective but most expensive. Screening with 4-chamber and outflow view, followed by referral to a specialist, were recommended as the least expensive strategy per defect detected. On average, articles met 17 of the 24 CHEERS criteria. Discussion: While recent cost-effectiveness analyses demonstrated improved methodological quality, there was a lack of homogeneity due to differences in comparators and population subgroups analyzed. Despite this heterogeneity, fetal ultrasonography screening was consistently identified as a cost-effective strategy, with its cost-effectiveness heavily influenced by the expertise of the interpreting physician. Conclusion: Most studies recommend implementing obstetric ultrasonography screening, without routine fetal echocardiography, for detecting congenital heart diseases.

Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country.

BACKGROUND: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. METHODS: Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. RESULTS: In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. CONCLUSIONS: Resternotomy in pediatric cardiac surgery is a safe procedure in our center.

XXI Congreso Colombiano de Cardiología / XXI Colombian Congress of Cardiology

La difusión del conocimiento es una de las actividades prioritarias de la Sociedad, por lo cual nuestro congreso de realización bienal y nuestra revista de cardiología, constituyen las herramientas principales para el logro de ese fin. Así mismo, para la Sociedad es motivo de gran satisfacción el haber recibido el mayor número de trabajos científicos en la historia de todos los congresos, para esta nueva versión del congreso. En la modalidad de trabajos de concurso se aceptaron treinta y seis, los cuales fueron evaluados por cinco jurados nacionales, entre ellos tres cardiólogos epidemiólogos. Igualmente, se aceptaron doscientos sesenta y tres trabajos enviados para presentación de póster, los cuales fueron divididos en ocho categorías: 1. Cardiología clínica, prevención, factores de riesgo y rehabilitación. 2. Investigación básica 3. Cirugía cardiovascular. 4. Cardiología pediátrica y cirugía cardiovascular pediátrica. 5. Cardiología no invasiva, medicina nuclear y ecocardiografía. 6. Cardiología intervensionista. 7. Electrofisiología. 8. Cuidado intensivo y enfermería. Cada grupo de estos trabajos se envió a jurados internacionales (solamente dos se evaluaron por jurados nacionales), quienes los evaluaron sin previo conocimiento del autor ni de la institución o ciudad donde se realizó el estudio, y quienes a su vez hicieron comentarios favorables y constructivos para el mejoramiento de la calidad de los mismos Este hecho muestra que el conocimiento nacional, tanto en investigación básica como clínica, estará al alcance de más de 2.000 asistentes al evento, y que se cumplirá así con el propósito enunciado y con el deseo de que esta sección del congreso sea la de mayor trascendencia. Las conferencias se diseñaron pensando en la diversidad de especialistas y médicos generales y se espera que el programa cumpla con las expectativas de los asistentes. En esta oportunidad se tendrán los Clinicardios para actualización de médicos que asistan en temas específicos, además de cursos de profundización con expertos, en los cuales se desea una fructífera interacción con el conferencista extranjero. De otra parte, se estimula para que cada vez se estructuren mejor las actividades realizadas por los residentes de las especialidades, así como del comité de enfermería, mano derecha de nuestra labor diaria. Dentro de las actividades del Congreso Colombiano de Cardiología, se celebra por primera vez el congreso del Colegio Colombiano de Hemodinámica, en sesiones especiales que permitirán no sólo el desarrollo sino la interacción entre esta y las otras especialidades de los médicos asistentes. Finalmente, el esfuerzo realizado por los presidentes del comité científico, la colaboración de los responsables de los diversos comités y capítulos ha sido invaluable y deseamos que éste goce de aceptación y contribuya al crecimiento intelectual y al acercamiento institucional de todos los participantes