Heart surgery

Frailty is more common in children who have heart surgery than previously thought

A third of patients who underwent a complex procedure for severe congenital heart disease were identified as frail during a routine clinic visit, with providers inconsistently acknowledging this, according to a new study.

Children with congenital heart disease who are considered frail may especially have an increased risk of poor health outcomes after heart surgery. However, little is known about the frequency of frailty in some populations of children.

New research suggests it’s more common than previously estimated.

The study included 54 patients who underwent open heart surgery known as the Fontan procedure, which is the latest procedure after a series of cardiac surgeries needed for patients born with single ventricular-type heart disease.

“In adults with chronic illnesses, we know that those considered frail have an increased risk of poor health outcomes. But it hasn’t been well studied in the pediatric population, ”says lead author Heang Lim, pediatric cardiologist at CS Mott Children’s Hospital at the University of Michigan Health.

“We wanted to know if the frailty of this group of young cardiac patients was associated with adverse health effects. These results highlight the need for improved screening and support for an at-risk population that providers are not always able to identify. “

Frailty was assessed using several measures, including slowness, weakness, exhaustion, and decreased physical activity before and after surgery. But doctors weren’t able to reliably predict their patients’ risk of frailty, Lim notes.

Factors associated with frailty include protein loss enteropathy (some heart patients experience severe protein loss in the gut) and at least one hospitalization in the past year. Frail patients also had lower physical functioning and higher rates of healthcare use, according to the authors.

Fontan’s procedure is one in a series of reconstructive heart surgeries to help redirect blood flow in children with congenital heart conditions affecting a lower chamber of the heart or unique ventricular defects.

These babies might have a smaller or underdeveloped chamber or not have a valve due to heart problems like hypoplastic left heart syndrome, tricuspid atresia, and double-exit right ventricle.

“We know that a portion of children who undergo Fontan’s procedure develop late complications that include some form of heart failure and may require a heart transplant,” Lim said.

“If we could identify frailty in an individual, it could help us better understand their surgical risks and possibly look for interventions that might make them less fragile and therefore improve their chances of a successful heart transplant. “

More studies are needed to better understand pediatric frailty, its reversibility and whether it predicts vulnerability to adverse health effects as in adults, says Lim.

The researchers recently shared their findings during the American Heart Association’s Virtual Science Sessions.

Source: University of Michigan


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