Congenital Cardiac Surgery Across Continents: Excellent Outcomes With Patients From the Middle East Operated on in the United States

Vollständiger Abstract

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Background A subset of children with congenital heart disease (CHD) travel internationally for definitive cardiac surgery, yet outcome data for selectively referred international patients undergoing complex congenital cardiac procedures remain limited. We describe results for international pediatric cardiac patients operated on within a structured referral model at a US tertiary congenital cardiac center. Methods From September 2020 to July 2025, 1465 patients underwent cardiac surgery at our institution. Sixty-six consecutive international patients underwent 117 procedures, coordinated through Global Services. Demographics, diagnoses, operative variables, and outcomes were analyzed. Results Median age was 53 months (interquartile range [IQR] 12-140) and weight 15.6 kg (IQR 8.5-39.5); 62% (41/66) were male. Referring countries were the United Arab Emirates (37/66, 56%), Kuwait (35%, 23/66), and Qatar (9%, 6/66). Prior cardiac surgery occurred in 74% (49/66), and 58% (38/66) had ≥2 sternotomies; 25% (17/66) had single-ventricle physiology. Society of Thoracic Surgeons – European Association for Cardio-Thoracic Surgery Congenital Heart Surgery category 3 to 5 procedures accounted for 48% (32/66) of the cases. Median cardiopulmonary bypass time was 174 min (IQR 120-255) and cross-clamp time 83 min (IQR 33-137). There was no hospital mortality. Early reoperation occurred in 7.5% (5/66) (3% for bleeding). Median intensive care unit and hospital stay were 5 (IQR 3-12) and 11 days (IQR 7-30). Major complications included extracorporeal membrane oxygenation, stroke, and dialysis in 1 patient each (1.5% each) and vocal cord injury in 6/66 (9%). Over a mean follow up of 312 days, 2 late deaths occurred (6 months and 1 year). Conclusions International patients with CHD can achieve excellent early outcomes despite high complexity when managed at experienced centers with structured referral coordination and multidisciplinary infrastructure.