IJCS | Volume 31, Nº4, July / August 2018

375 Jesus et al. The wait for surgical treatment of heart disease Int J Cardiovasc Sci. 2018;31(4)374-382 Original Article The estimated need for surgical procedures to repair congenital heart defects is 7.2 per thousand births, with reports of more significant deficits for treatment in the North and Northeast Regions, with rates close to 90%, and less significant in the Southern andMidwest regions, with rates of 46.4% and 57.4%, respectively. 8,9 Congenital heart diseases are important causes of hospital admissions in the pediatric population, and the earlier the diagnosis and the therapeutic intervention of these conditions, the lower the mortality and hospital readmission rates, and the better the quality of life of these children. 10 Considering the severe or potentially severe nature of these cardiopathies, which may have significant effects for morbidity and mortality, it is essential to know the reality of heart diseases in the only public referral hospital for these conditions in the State of Pará, Brazil. The aim of this study was to analyze the waiting time for elective surgical and/or interventional treatment in children with congenital heart defects in a cardiology referral center, as well as to evaluate the patients’ origin and make considerations about heart diseases and their types of treatment in that institution. Methods Cross-sectional study of patients aged 14 years or less, diagnosed with congenital cardiac malformations, who were waiting for surgical or percutaneous cardiac treatments, including reoperation cases. The data were obtained from the medical and statistical archive service (SAME) of Fundação Hospital de Clínicas Gaspar Vianna . The study variables were: gender, age, place of residence, diagnosis and time waiting for the procedure. Additionally, data frompatients submitted to surgical and/or catheterization treatment were collected from January 2012 to October 2014. The descriptive analysis of data was performed using the BioStat program, and the variables were shown as measures of central tendency anddispersionor frequencies. The present study was submitted to and approved by the Research Ethics Committee Involving Human Beings of Fundação Hospital de Clínicas Gaspar Vianna, under CAAE number 39903014.2.0000.0016. Results Of the 417 children waiting for cardiac surgery or hemodynamic procedure, 407 had a diagnosis of congenital heart disease; of these, 55.1% were females, and the most prevalent age groups were preschoolers (> 2 to 6 years), with 34.0%, and schoolchildren (> 6 to 12 years), with 33.3% (Table 1). The mean age was 5.7 (± 3.9), with a median of 5.0 years, ranging from 1 month to 14 years. There were no neonates waiting for treatment. The mean waiting time, in months, was 23.1 ± 18.3, with a median of 19, a minimum of 1 month and a maximum of 94 months. The two patients who had been waiting for 91 and 94 months (longer waiting periods) were incommunicable by the social service of the institution, which may justify the delay. Regarding their origin, 36.6% came from the municipality of Belém Metropolitan Mesoregion, followed by 27.2% from theNortheast of Pará, 17.6% from the Southeast of Pará and the remaining 18.1% from the Lower Amazon region, Southwest of Pará and Marajó together; one patient was from Amapá state (Figure 1). The most commonly diagnosed type of congenital heart disease was ventricular septal defect (VSD), isolated or associated with other cardiac malformations, totaling 28.98%, followed by persistent ductus arteriosus (PDA) with 18.42%, atrial septal defect (ASD) with 11.05%, with or without associations, and Tetralogy of Fallot, with 8.59% (Table 2). Regarding the performed surgeries, in 2012, 172 children underwent 201 pediatric cardiac surgeries; in 2013, 176 patients underwent 207 surgeries; and in 2014, until October 146 children underwent 158 cardiac surgeries. In 85.3% of the cases, it was possible to determine whether the child was previously enrolled for elective treatment or not: in 2012, 62.2% were not enrolled, being submitted to emergency procedures, and only 37.7% belonged to the elective enrollment group. In 2013, the same thing occurred, with 59.0% and 40.9% of cases, respectively (Table 3). In 2012, an average of 16.7 pediatric heart surgeries were performed per month. In 2013, this average was 17.2 and in 2014, until the end of October, of 15.8. Among pediatric hemodynamic procedures, there was a greater increase: in 2012, the average number of monthly procedures was 9.5, in 2013, 9.8 and until October 2014, 13.6 (Table 4). Regarding the type of hemodynamic procedure, the rate of cardiac diagnostic catheterization was 73.9%, while the rate of therapeutic interventions corresponded to 26.1% of the total procedures performed since 2012 (Table 5, Figure 2).