Relevance:

In modern medicine, the search for and development of prognostic scales for assessing patient status before surgery continues, taking into account advances in diagnostic methods and clinical characteristics.

Materials and Methods

A primary analysis was conducted on 124 newborns and children with congenital heart disease (CHD) hospitalized in the Cardiac Surgery Department of the Almaty National Center for Preventive Surgery (NCPSH) between 2012 and 2018. All patients underwent a comprehensive set of modern instrumental and laboratory tests, as well as consultations with specialized specialists. Aristotle's score was used for assessment.

Results:

Patients were divided into 3 comparison groups according to the basic Aristotle scale: Group 1 (RVSD, ASD, aortopulmonary window - 6 points) - n -65; Group 2 (9 points, RVCA, OOAVK, TF, TAPV) - n -30; Group 3 (RVCA TMS, OSA - 11 points) - n -29. In Group 1, 83% ( n -54) were diagnosed with comorbid diseases; in group 2 in 56% ( n - 17); in group 3, comorbid diseases accounted for 68% ( n - 20). In 75%, the comorbid pathology was represented by perinatal encephalopathy; in 56% - extracardiac congenital malformations, including multiple congenital malformations (MCM); in 53% - pneumonia, in 34% - intrauterine infections and sepsis, in 23% - bronchopulmonary dysplasia (BPD); genetic syndromes in 34%, blood diseases in 12% of cases and others - 11%. Distribution in the developed stratification assessment of comorbid status was carried out according to the severity of comorbidity based on the analysis of clinical and laboratory data, assessment of being on mechanical ventilation, in the intensive care unit, the need for inotropic support, additional costs and drug therapy, as well as taking into account the patient's age at the time of surgery. For example: newborn - 1 point; intraventricular infection in the acute phase - 1 point; PEP - 0.5 points (points); intraventricular hemorrhage and hydrocephalus - 1 point; pneumonia - 1 point; BPD - 1 point; extracardiac congenital malformations - 1 point; microcephaly - 2 points. Taking into account the stratification according to the developed scale, we noted that in the 1st group of subjects, the overall assessment of the risks of developing complications increased in 76% of cases to 10-12 points; in the second group, in 60% of cases, to 11-14 points; in the 3rd group, in 56%, to 13-15 points. Thus, stratification by background comorbid pathology along with the Aristotle scale increased the total scale of risks of developing complications in patients, made it possible to predict the course of the postoperative period and improve treatment and diagnostic measures in this category of patients.

TBA