Complicated postoperative period after heart surgery in children with Down syndrome

Introduction. Trisomy 21, or Down syndrome (DS), is the most common chromosomal abnormality worldwide and is often considered a risk factor for complications and adverse outcomes in surgical treatment of congenital heart defects (CHD).
Materials and methods. This was a retrospective single-center comparative study that included 440 children who underwent surgery for CHD. Patients with DS constituted the first (study) group (n = 57), while the second (control) group included patients without genetic disorders (n = 383).
Results. Patients with DS had lower body weight – 4.8 kg versus 5.9 kg in patients in the control group (p = 0.017). The most frequently performed procedure in both groups was ventricular septal defect repair, in 33.0% and 39.6% of cases for the first and second groups, respectively (p = 0.61). Radical correction (RC) of the atrioventricular canal was more often performed in patients of the main group (p < 0.001). In patients with DS, staged treatment of CHD was more often performed, since pulmonary artery narrowing as the first stage of hemodynamic correction was performed in 22.8% of patients in the first group (p < 0.01). Conotruncal defects (tetralogy of Fallot (TOF) and double outlet right ventricle) were less common in patients with trisomy 21 than in patients with a normal chromosomal set (p = 0.031). Among the postoperative complications, respiratory failure (RF) was the most common in both groups, but developed more frequently in patients with trisomy 21 – in 26.3% of cases (p = 0.029). Patients with DS required longer duration of mechanical ventilation (MV) (p = 0.019), non-invasive respiratory support (p = 0.007), and inotropic support (p = 0.012). The duration of intensive care in the intensive care unit (ICU) (p = 0.023) and mortality (p = 0.01) were also higher in patients in the study group. Systemic inflammatory response syndrome (SIRS) was not a frequent complication, but its incidence in patients with trisomy 21 was twice as high – 12.2% versus 6.5% in the control group (0.004). Mortality in the first group was higher, at 5.3% versus 2.1% in patients without chromosomal abnormalities (p = 0.011).
Conclusion. The postoperative period after cardiac surgery in children with trisomy 21 is more often complicated by respiratory failure, which requires longer periods of mechanical ventilation and more frequent use of non-invasive respiratory support. Respiratory failure is the most common postoperative complication in children with DS after cardiac surgery. Patients with trisomy 21 require a longer intensive care unit (ICU) stay compared to their peers without chromosomal abnormalities.

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