Authors: Nasr, Viviane G. et al.
Anesthesiology October 2025 | DOI: 10.1097/ALN.0000000000005783
This multicenter registry study characterized the incidence and predictors of intraoperative cardiac events in pediatric patients with congenital heart disease (CHD) undergoing noncardiac procedures. While previous studies focused primarily on mortality, this analysis—drawing from seven U.S. centers—specifically examined real-time intraoperative hemodynamic and cardiac complications across a large cohort.
Between January and December 2021, data were collected on 4,343 children (birth to 21 years) representing 6,455 procedures. Intraoperative cardiac events—defined as any episode of hemodynamic instability, cardiac arrest, or pulmonary hypertensive crisis—occurred in 335 procedures (5.2%) among 296 patients. Hypotension was the most frequent event (4.9%), followed by pulmonary hypertensive crises and 12 cases of cardiac arrest (0.2%).
Univariate analysis identified several independent risk factors associated with higher event rates: prematurity (OR 1.34, 95% CI 1.02–1.76), chronic gastrointestinal (OR 1.51) or respiratory disease (OR 2.12), preoperative ventilatory support (OR 3.88), concurrent respiratory illness (OR 2.18), major cardiac disease (OR 2.09), and severe CHD (OR 3.48). Emergency or high-acuity surgical procedures carried the greatest overall risk.
The findings demonstrate that intraoperative cardiac instability is relatively common in this vulnerable population and extends beyond mortality-related metrics. Children with complex or severe CHD—particularly those with respiratory compromise or undergoing emergency interventions—require meticulous preoperative optimization, multidisciplinary planning, and intraoperative hemodynamic monitoring to mitigate risk.
What You Should Know
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Intraoperative cardiac events occurred in 5.2% of pediatric CHD procedures, with hypotension as the leading issue.
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Severe CHD, respiratory comorbidity, and preoperative ventilatory support substantially increased risk.
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This registry underscores the need for tailored anesthetic management strategies and heightened vigilance during noncardiac procedures in children with CHD.
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