IJCS | Volume 33, Nº4, July and August 2020

DOI: https://doi.org/10.36660/ijcs.20200130 Congenital heart defect commonly requires care in pediatric intensive care unit (PICU). They are a heterogeneous group of disorders with an annual incidence of 25,757 new cases in Brazil, 12 cases per 1,000 inhabitants 1 . In this paper, Guimarães et al., 2 published a cross-sectional study to describe the epidemiology of patients admitted to PICU from a tertiary hospital in Brazil. In this editorial, we review recent progress in understanding the risk factors for mortality in PICU. The editorial was produced by searching Pubmed and Scielo, using the terms “PICU”, “RACHS”, “CHD”, and “mortality”. Congenital heart defects (CHD) are serious and common conditions that have a significant impact on morbidity, mortality and healthcare costs in both children and adults. 3 It is estimated that at least 32,000 infants in the United States will be affected each year by CHD. 3 Of these, approximately 25%, or 2.4 per 1,000 live births require invasive treatment in the first year of life. While advances in treatment in the last decades have decreased infant mortality, they have also led to an increase in the number of children and adults with CHD. 4 Despite these advances and developments in interventional and surgical techniques, heart disease in children remains an important cause of morbidity and mortality. 5 Al t hough a cqu i r ed de f e c t s con t r i bu t e t o hospitalizations in PICU, congenital diseases are more prevalent. In developed countries, Kawasaki disease is the main cause of acquired heart disease in children younger than five years old. In underdeveloped and developing countries, such as Brazil, rheumatic carditis is the main cause of acquired heart disease. In the series Guimarães et al., 2 acquired heart disease accounted for 8.1%, with rheumatic heart disease being the main cause. The most common diagnoses of acyanotic heart defects were interventricular communication (24.5%), followed by total atrioventricular septal defect (19.9%), persistent arterial channel and interatrial communication (13.2% each) and coarctation of the aorta (11.9%). Among the cyanotic congenital heart defects, the most common was tetralogy of Fallot (30%), followed by tricuspid atresia (17.6%), complex heart diseases (15.3%), pulmonary atresia (9.9%), transposition of the great arteries (9.2%),  complex heart diseases with PS (6.1%), total anomalous pulmonary venous return  (6.1%), single ventricle and truncus arteriosus (2.3% each) and Einstein anomaly (0.8%). These data coincide with those published by several authors. Like other authors, Guimaraes, et al., 2 used the risk stratification of patients admitted to the PICU: the RACHS score. The RACHS-1 score is a simple model that can be easily applied because it requires little data. Despite having some shortcomings as low individual predictive power and disability of classification of all cardiac procedures, 6 it has been widely used to compare mortality among services and to evaluate the evolution of the quality of care provided. Because it is a good predictor of mortality, it has beenwidely used to compare mortality among services and to evaluate the evolution of the quality of care provided. 7 However, the RACHS-1 score does not address individual and structural factors of a service that can directly affect surgical outcomes. 6 In open heart surgery, due to cardiomyopathy pulmonary bypass (CPB), which has different effects on different organs of the body, it is more likely to develop complications during or after surgery. 8 Almost 400 thousand open heart surgery using pump cardiovascular (CPB) are performed worldwide, out of which about 6% in children. 9 To better prevent these complications and improve the prognosis of action, identification of mechanisms, incidence and risk factors play a major role. 10 337 EDITORIAL International Journal of Cardiovascular Sciences. 2020; 33(4):337-339 Mailing Address: Cristiane Martins Biocor Hospital de Doenças Cardiovasculares Ltda – Cardiologia Pediátrica Alameda Oscar Niemeyer, 217. Postal Code: 34000-000, Nova Lima, MG – Brazil. E-mail: cristianemar@hotmail.com Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit Cristiane Martins 1 and Bruna M. N. Gama 1, 2 Biocor - Hospital de Doenças Cardiovasculares, 1 Nova Lima, MG – Brazil Faculdade de Medicina de Barbacena, 2 Barbacena, MG – Brazil. Editorial related to the article: Clinical and Epidemiological Profiles of Patients Admitted to a Pediatric Cardiac Intensive Care Unit Heart Defects Congenital/mortality; Risk Factors; Mordity; Intensive Care Units; Hospitalization; Heart Septal Defects, Ventricular; Aortic Coarctation; Arterial Switch Operation. Keywords