Outcomes of spinal fusion in children with congenital heart disease

Nathaniel W. Taggart, William J. Shaughnessy, Anthony A. Stans, Amy L. McIntosh, David J. Driscoll

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: The children with congenital heart disease (CHD) have an increased risk of developing scoliosis. Many children with CHD may benefit from surgical intervention for scoliosis. However, there is uncertainty about the safety of spinal fusion in children with heart disease. The purpose of this study is to assess whether spinal fusion is safe and effective for children who have CHD. Methods: We reviewed all the cases of children with CHD undergoing first-time spinal fusion for spinal deformity at Mayo Clinic between August 1976 and June 2008. Data were abstracted regarding cardiac history, major Cobb angle, type of spinal fusion (anterior, posterior, or both), intraoperative and postoperative complications, mortality, and follow-up. Results: Sixty-four children under the age of 18 (64% female patients; mean age = 11.5 y) were included in the study. The most common types of CHD were pulmonary atresia with ventricular septal defect and tetralogy of Fallot. Sixty-three percent of all patients had had prior cardiac surgery; 22% were cyanotic at the time of spinal fusion. Nine patients had single-ventricle physiology; 5 of whom had had Fontan palliation. Nine patients had pulmonary hypertension. Posterior fusion alone was carried out for 69% of the patients. Spinal instrumentation was used in 70% of cases. Average anesthesia time was 7.3 hours. Mean hospital stay was 9 days. Eighteen children (30%) required prolonged intubation of 1 day or longer. Prolonged intubation was more common in patients with a larger Cobb angle and in patients with pulmonary hypertension. Postoperative complications occurred in 27% of all patients and were more common in the patients with pulmonary hypertension. One child died postoperatively from a hemorrhage because of an arterial-esophageal fistula unrelated to her spinal fusion. Conclusions: Spinal fusion in children with CHD is generally safe and effective. Children with pulmonary hypertension are at higher risk for complications from spinal fusion.

Original languageEnglish (US)
Pages (from-to)670-675
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume30
Issue number7
StatePublished - Oct 2010

Fingerprint

Spinal Fusion
Heart Diseases
Pulmonary Hypertension
Scoliosis
Intubation
Esophageal Fistula
Tetralogy of Fallot
Intraoperative Complications
Thoracic Surgery
Uncertainty
Length of Stay
Anesthesia
History
Hemorrhage
Safety

Keywords

  • Children
  • Congenital heart defects
  • Pulmonary hypertension
  • Scoliosis
  • Spinal fusion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Taggart, N. W., Shaughnessy, W. J., Stans, A. A., McIntosh, A. L., & Driscoll, D. J. (2010). Outcomes of spinal fusion in children with congenital heart disease. Journal of Pediatric Orthopaedics, 30(7), 670-675.

Outcomes of spinal fusion in children with congenital heart disease. / Taggart, Nathaniel W.; Shaughnessy, William J.; Stans, Anthony A.; McIntosh, Amy L.; Driscoll, David J.

In: Journal of Pediatric Orthopaedics, Vol. 30, No. 7, 10.2010, p. 670-675.

Research output: Contribution to journalArticle

Taggart, NW, Shaughnessy, WJ, Stans, AA, McIntosh, AL & Driscoll, DJ 2010, 'Outcomes of spinal fusion in children with congenital heart disease', Journal of Pediatric Orthopaedics, vol. 30, no. 7, pp. 670-675.
Taggart NW, Shaughnessy WJ, Stans AA, McIntosh AL, Driscoll DJ. Outcomes of spinal fusion in children with congenital heart disease. Journal of Pediatric Orthopaedics. 2010 Oct;30(7):670-675.
Taggart, Nathaniel W. ; Shaughnessy, William J. ; Stans, Anthony A. ; McIntosh, Amy L. ; Driscoll, David J. / Outcomes of spinal fusion in children with congenital heart disease. In: Journal of Pediatric Orthopaedics. 2010 ; Vol. 30, No. 7. pp. 670-675.
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abstract = "Background: The children with congenital heart disease (CHD) have an increased risk of developing scoliosis. Many children with CHD may benefit from surgical intervention for scoliosis. However, there is uncertainty about the safety of spinal fusion in children with heart disease. The purpose of this study is to assess whether spinal fusion is safe and effective for children who have CHD. Methods: We reviewed all the cases of children with CHD undergoing first-time spinal fusion for spinal deformity at Mayo Clinic between August 1976 and June 2008. Data were abstracted regarding cardiac history, major Cobb angle, type of spinal fusion (anterior, posterior, or both), intraoperative and postoperative complications, mortality, and follow-up. Results: Sixty-four children under the age of 18 (64{\%} female patients; mean age = 11.5 y) were included in the study. The most common types of CHD were pulmonary atresia with ventricular septal defect and tetralogy of Fallot. Sixty-three percent of all patients had had prior cardiac surgery; 22{\%} were cyanotic at the time of spinal fusion. Nine patients had single-ventricle physiology; 5 of whom had had Fontan palliation. Nine patients had pulmonary hypertension. Posterior fusion alone was carried out for 69{\%} of the patients. Spinal instrumentation was used in 70{\%} of cases. Average anesthesia time was 7.3 hours. Mean hospital stay was 9 days. Eighteen children (30{\%}) required prolonged intubation of 1 day or longer. Prolonged intubation was more common in patients with a larger Cobb angle and in patients with pulmonary hypertension. Postoperative complications occurred in 27{\%} of all patients and were more common in the patients with pulmonary hypertension. One child died postoperatively from a hemorrhage because of an arterial-esophageal fistula unrelated to her spinal fusion. Conclusions: Spinal fusion in children with CHD is generally safe and effective. Children with pulmonary hypertension are at higher risk for complications from spinal fusion.",
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