How to Choose a Hospital for Treating Your Child’s Congenital Heart Defect

High-volume hospitals are better for complex cases

When your child has a congenital heart defect, of course you want to get it fixed as soon as possible. But there’s good reason to slow down and think carefully before deciding where your child should have heart surgery.

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A recent U.S. News & World Report analysis showed that 26 percent of the deaths that occurred following surgery for the most severe heart defects were preventable. What’s the key to preventing them? Choosing a hospital that performs the procedures frequently.

The Society of Thoracic Surgeons separates hospitals that perform congenital heart surgery into three categories:

  • Low volume — an average of fewer than 100 patients per year
  • Medium volume — an average of 100 to 249 patients per year
  • High volume — an average of 250 or more patients per year

Surgeries performed at high-volume hospitals tend to have better outcomes, especially when the surgeries are more complex.

“We know for a fact that the more a hospital does a procedure, the better the outcome,” says pediatric cardiothoracic surgeon Hani Najm, MD, Chairman of Pediatric and Congenital Heart Surgery at Cleveland Clinic.

“It matters how many times that surgeon or that center has done the procedure. When they do the same procedure frequently, they get better at it,” he says.

Dr. Najm also suggests considering four other important factors when evaluating hospitals and surgeons:

1. How complex is the surgery?

“If there’s a rare defect, you need to go to a high-volume center where they’ve seen that kind of anomaly,” Dr. Najm says. The Society of Thoracic Surgery (STS) created levels of complexities for congenital heart defects. There are five levels; The higher the level, the more complex the lesion is. Therefore, level 4 and 5 should be done in a high volume center, and by an experienced surgeon.

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If the heart defect is a more common one, a low-volume hospital is often fine. Doctors at low-volume centers are likely to have good experience with these less complex procedures, he says.

Dr. Najm notes that going to a high-volume center can involve considerable expense and travel. This likely isn’t necessary if the problem is one that a low-volume hospital performs often.

2. How extensive is the surgeon’s experience?

“You want a surgeon who has a track record of doing many cases, including the complex cases,” Dr. Najm says. When the defect is highly complex, an experienced physician is imperative.

Sometimes large centers have a range of surgeons. Families should look at different surgeons within the same center to find the best fit for their particular needs, he says.

3. Does the surgeon have a good relationship with his or her patients?

“The level of trust between the parents and the surgeon is critically important,” Dr. Najm says.

During your interview with the surgeon, you should get a clear explanation of the type of heart defect, the type of surgery required, and what to expect before and after the surgery.

Dr. Najm also suggests that you speak to the family members of other patients whom the surgeon has treated, if possible.

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“It is my duty to give parents confidence that their child is going to get the best care in my hands and in my center’s hands,” he says. “That is what parents should feel like when leaving the surgeon’s office.”

4. What is the center’s rating on the Society of Thoracic Surgeons Public Reporting site?

This database rates congenital heart surgery programs with one, two or three stars, based on their surgery outcomes. This is reasonably reflective of the overall performance of the program, Dr. Najm says.

Not all programs choose to participate, though, so your local hospital may not have a rating on the site. If it doesn’t, ask the hospital for this information directly, Dr. Najm says.

Although it’s frightening to hear that your child has a congenital heart defect, there’s no need to panic, he says. If you take some time to research surgeons and hospitals it’s not too difficult to determine where your child will get the best care.

“We have come a long way in improving the early outcome and long-term survival of children born with congenital heart defects,” Dr. Najm says.

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