Palliative surgery for congenital heart desease in children: role and outcomes

Abstract

Objective: This study aimed to evaluate the role and outcomes of palliative surgery in the management of congenital heart disease at the Pediatric Cardiac Surgery Intensive Care Unit, Chợ Rẫy Hospital, from March 2017 to February 2026.

Methods: A retrospective descriptive cross-sectional study was conducted on all pediatric patients who underwent palliative cardiac surgery at the Pediatric Cardiac Surgery Intensive Care Unit, Chợ Rẫy Hospital, between March 2017 and February 2026. Clinical characteristics and treatment outcomes were collected from medical records and analyzed using statistical methods.

Results: During the study period, 115 pediatric patients underwent palliative cardiac surgery, of which systemic-to-pulmonary shunt (41.7%) and Bidirectional Glenn shunt (47%) were the most commonly performed procedures. The age at surgery varied among groups, with procedures such as pulmonary artery banding and the Norwood operation primarily performed in younger patients. Most patients presented with moderate heart failure, with Ross class II accounting for 43.5% and class III for 27.8%, and decreased pulmonary blood flow was the most common hemodynamic pattern (46.9%). The median operative time ranged from 130 to 390 minutes, and the cardiopulmonary bypass time (with CPB): ranged from 90 to 300 minutes. Postoperative complications included reoperation (17.3%), shunt thrombosis (13%), pleural effusion (4.3%), and mortality (12.1%). A total of 55.6% of patients subsequently underwent second-stage surgery.

Conclusion: Palliative surgery plays an important role in the management of complex congenital heart disease, serving as the initial stage in its treatment. The systemic-to-pulmonary shunt (41.7%) and the Glenn shunt (47%) are the two main procedures. Most patients undergo intervention at the stage of moderate heart failure (Ross class II–III: 71.3%). The overall mortality rate is 12.1%. At the time of analysis, 55.6% of patients proceeded to second-stage surgery, demonstrating the effectiveness of a staged treatment strategy.