Post-operative care for patients having undergone cardiothoracic surgery for congenital heart disease requires clinical expertise and experience of both physicians and nurses. The literature suggests institutions and surgeons with higher case numbers have better pediatric cardiac surgery outcomes.

At Vanderbilt clinical acumen regarding post-op cardiac care has been concentrated in the Pediatric Intensive Care Unit where care is coordinated between Pediatric Cardiothoracic Surgeons, Cardiologists, and Intensivists. All pediatric patients who have undergone open heart surgery and required cardiopulmonary bypass should recover in the PICU.

Neonatal patients recovering from cardiac surgery may be readmitted to the NICU in the following circumstances:

1. Status post PDA ligation

OR

2. Once their acute cardiac surgical issues are fully resolved if they continue to need intensive care for other organ system failure

and

3. their post-conceptional age remains less than 44 weeks, or
4. they have previously been patients of the NICU where continuity of care could best be achieved.

References:

Jenkins KJ, et al. In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 1995; 95: 323-330.

Hannan EL, et al. Pediatric cardiac surgery: The effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 1998; 101: 963-969.

Discussed at Clinical Division Meeting 5/21/01