As a quality improvement initiative, the Pediatric and Congenital Heart Center at Children’s of Alabama carefully records all clinical outcomes after pediatric heart surgery, including survival. Survival rates reflect the percent of patients who survived until hospital discharge. Tracking these outcomes enables us to identify potential areas for improvement as well as to address frequently asked questions from families. Our outcomes are compared to 111 pediatric cardiac surgery centers in the United States and Canada through the Society of Thoracic Surgeons (STS) registry. The overall survival in our program is greater than 96%, which is the same as the STS registry survival rate.
The team at Children's of Alabama and University of Alabama at Birmingham performs about 400 pediatric and adult congenital cardiac surgeries per year. A comprehensive spectrum of cases are performed in all age groups, including open heart and closed heart surgeries, "hybrid" cases (combined heart catheterization and surgery), heart transplants, ventricular assist devices (artificial hearts) and extracorporeal membrane oxygenation (ECMO).
Our surgical volume is diverse and ranges from relatively low risk operations to very complex cases. Operations are classified by STAT Categories developed by STS and EACTS. Operations are categorized by complexity of the procedure from 1 (low risk) to 5 (high risk). STAT Category 1 includes cases such as atrial septal defect repair (ASD) and ventricular septal defect repair (VSD). Tetralogy of Fallot repair is STAT Category 2 . Complete AV Canal and the arterial switch operation is STAT Category 3, while arterial switch operation with VSD repair is STAT Category 4. The most complex case, the Norwood procedure, is STAT Category 5.
Our busy Advanced Heart Failure and Transplant Team has performed 165 pediatric heart transplants since 1981; 44 transplants were performed in the past 5 years and 25 transplant were performed in the past 3 years. The excellent short term and long term survival of our heart transplant recipients is above national average as reported by the Scientific Registry of Transplant Recipients. Our program also features a robust ventricular assist device (VAD) program and an emerging total artificial heart program. In the last 3 years 10 children have received VADs: 1 Berlin heart, 5 HeartWare and 4 CentriMag. In the last 5 years 19 children have received VADs: 7 Berlin hearts, 8 HeartWare and 4 CentriMag. Our state of the art ECMO program that provide cardiac support for children with failing hearts until they can receive a heart transplant or their own heart recovers. 10-15 patients are supported with cardiac ECMO per year. Survival to hospital discharge for patients requiring cardiac ECMO over the last two years is 55%, which is higher than international average as reported by the Extracorporeal Life Support Organization.
Length of Stay—The Children’s of Alabama Heart Center works diligently toward reducing the number of days a patient spends in the hospital after cardiac surgery. Children that have excellent surgery and uncomplicated postoperative courses have shorter length of stays. Our program consistently has relatively short hospital stays across all surgical diagnoses. We know reduced length of stay is associated with better outcomes, lower costs and increased patient-family satisfaction.
Length of Mechanical Ventilation—The CVICU team at Children’s of Alabama Heart Center strives to continually improve our patients’ outcomes and understands quality improvement projects drive our team to achieve these goals. One of those projects was to design and implement a ventilator weaning protocol in which we were able to decrease the duration of mechanical ventilation by 40% after cardiac surgery. We know reduced length of mechanical ventilation is associated with better outcomes, less infections, less lung injury, lower costs and increased patient-family satisfaction. Below you will see the average time a child remains on the ventilator based on STAT category and surgical diagnosis.