Retrospective descriptive study of the first cohort of patients operated for congenital and paediatric heart disease on Reunion Island between 2015 and 2020

Background Prior to 2016, children with acquired or congenital heart disease (CHD) in the French Indian Ocean (Reunion, Mayotte) were systematically transferred to metropolitan France if they required cardiac surgery or interventional cardiac catheterization. This resulted in a difference in care compared to children born in metropolitan France due to the risks of a long air transfer (mortality 2%, morbidity 24%, medico-technical and logistical problems 18%) [1] , the distance from families and the costs of medical evacuations. Since the end of 2015, monthly sessions of CHD surgery have been held with an agreement between the university hospitals of Reunion and Bordeaux with the aim to created the first CHD medical and surgical center in the Indian Ocean. Objective Describe the epidemiological characteristics of the first cohort of children operated for congenital and acquired heart disease in Reunion Island. Evaluate the postoperatives outcomes of CHD surgery in children in Reunion Island. Methods Medical records of patients under 18 years old undergoing open heart surgery at the university hospital of Reunion Island from October 2015 to December 2020 were reviewed. Results A total of 96 children underwent open heart surgery during the study period. The mean age of the patients was 7.4 years; 16.7% were infants; 11.5% had a genetic or chromosomal syndrome. The sex ratio was 1.1. The main CHD were: atrial septal defects (ASDs) 24% and ventricular septal defects (VSDs) 19.8%. The main acquired heart disease were: rheumatic heart disease 7.3% and endocarditis 5.2%. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and AVSD. The median Aristotle score was 6 and 31% had an Aristotle score ≥ 8. One hundred percent patients received reconstructive surgery. CPB was performed in 87.5%. There were major complications in 21 patients with postoperative acute renal failure requiring temporary dialysis (2%), postoperative mechanical circulatory support (3.1%), unplanned reoperation (10.4%), pneumothorax (5.2%), septic shock (2%), haemorrhagic shock (3.1%), ventricular fibrillation (1%). Postoperative sepsis occurred in 28.1%. Prolonged CPB (≥ 120 minutes) was associated with prolonged hospitalization, renal failure, left ventricular dysfunction and infections. The median duration of mechanical ventilation was 12 hours (IQR: 4.75–24). The median length of stay (LOS) in intensive care was 3 days (IQR: 2–4). The median postoperative LOS in hospital was 7 days (IQR: 6–12). Complete repair for 74% and residual lesions for 24%. The overall mortality rate was 2%. The 6-month survival was 97%. Conclusions The experience in university hospital of Reunion Island has shown that conducting open heart surgery operations at local sites it possible and positively impacts on the ability of local cardiac teams to have hands on training. Evaluation of postoperative morbidity provides important information and should become a focus of quality improvement to continue the development of a pediatric cardiac surgery center in Reunion Island.