IJCS | Volume 33, Nº4, July and August 2020

In a recent single-centered study with a total of 2,308 paediatric patients submitted to cardiac surgery with cardiopulmonary bypass support, Xien Zeng et al., 11 noted that 677 (29.3%) of the surgeries resulted in postoperative complications and 1.631 (70.7%) did not. The mean surgical age was 22 (±30) months, and 1,151 (49.9%) patients were male. The risk factors evaluated for 2,308 patients stratified by postoperative complication revealed that patients who underwent surgery and experienced postoperative complications were significantly younger, lighter and shorter. Lower blood oxygen saturation levels before and after surgery were also associated with postoperative complication. Moreover, a longer surgical time, CPB, aortic cross- clamping time and particularly delayed sternal closure were associated with complications. Therefore, the right incision thoracotomy will definitely reduce the risk of complications compared to the median sternal incision. Importantly, an emergent operation was a risk factor for complications. Certainly, patients with multiple heart defects who undergo multiple procedures in the same visit will have a higher risk of complications. 11 Cavalcante CT et al., 12 carried out a retrospective analysis of 3,071 patients, fromJanuary 2003 toDecember 2014, and noted that mortality also varied during the twelve years of records, with significant decrease despite an increase in the number of procedures, ranging from13.3% (171/1288) to 10.4% (191/1889) in the period II ( P =0.014). Mortality in the last three years was 9% (2012-2014). When they evaluated the deaths according to RACHS-1 category, they found that the more complex the procedure, the higher the mortality rate is ( P =0.0001), however when analyzing the association between RACHS-1 score and mortality in the two periods separately, was noted a decrease in mortality category in recent years, with the exception of category  6. 12 Another study analyzed a total of 325 patients: 271 with cardiopulmonary bypass and 54 without cardiopulmonary bypass. Of the 325 patients, 141 (43%) had complications (95% confidence interval, 38%-49%). Of the 325 patients, 82 (25%) developed cardiac and 120 (37%) developed extracardiac complications. The evidence from logistic regression analysis was insufficient to suggest a relationship between CPB support and the incidence of cardiac or extracardiac complications after adjusting for age, gender, previous sternotomy, and RACHS-1 levels. For patients receiving CPB, longer CPB times, higher RACHS-1 levels, and a lower temperature with CPB were associated with a greater number of cardiac complications. 13 A reduction in postoperative complications to improve outcomes in both adults and children undergoing a variety of surgical procedures has been a general focus for many researchers. In this study cohort, the overall mortality rate of patients with complications was 5.5% and the corresponding value in all patients was 1.6%. Furthermore, the postoperative length of hospital stay, length of cardiac intensive care unit stay andmechanical ventilation durationwere significantly longer for patients who experienced postoperative complications, compared to patients without complications. The ability to predict complications prior to it will really help clinicians improve the care process by optimizing critical care resources for high-risk patients. 11 Identifying and correcting complications early might change the relationship of complication development and mortality; thus, the downstream effects of a given complication might differ from institution to the next, depending on the infrastructure. The associations between complications and outcome might be most important in establishing patterns to target early recognition and preventive treatment. 1. Pinto Jr VC, Branco KMP, Castello RC, Carvalho W, Lima JR, Freitas SM, et al. Epidemiology of congenital heart disease in Brazil Approximation of the official Brazilian data with the literature. Rev Bras Cir Cardiovasc.2015;30(2):219-24. 2. Guimaraes JR, Guimaraes ICB. Clinical and epidemiological profiles of patients admitted to a pediatric cardiac intensive care unit. Int J Cardiovasc Sci. 2020; 33(4):331-336. 3. Roger VL. American Heart Association. Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2011 update: a report from the AHA. Circulation.2012;125(1):e2-e220. 4. Dolk H, Loane M, Garne E. Congenital heart defects in Europe. Circulation. 2011;123(8):841–9. 5. Baspinar O, Karaaslan S, Oran B, Baysal T, ElmaciAM, Yorulmaz EAM, et al. Prevalence and distribution of children with congenital heart diseases in the centralAnatolian region, Turkey. Turk J Pediatr. 2006;48(3):237–43. 6. Jenkins KJ, Gauvreau K. Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1)method. J Thorac Cardiovasc Surg. 2002;124(1):97-104. 7. Nakayama Y, Shibasaki M, Shime N, Nakajima Y, Mizobe T, Sawa T. The RACHS-1 risk category can be a predictor of perioperative recovery in Asian pediatric cardiac surgery patients. J Anesth. 2013;27(6):850-4. 8. Behrmans RE, Kleigman RM. Nelson Textbook of Pediatrics. 17 th .ed Philadelphia, PA: WB Saunders Co; 2004.chap: 417,418. References 338 Martins & Gama Risk Factors for Mortality in PICU Int J Cardiovasc Sci. 2020; 33(4):337-339 Editorial