Mortality and Risk Factors in Pediatric Cardiac Surgery for Congenital Heart Disease in Mexico

Objective: To describe surgical outcomes, in-hospital mortality, and variables associated with mortality in pediatric patients with congenital heart disease (CHD) at a national referral center in México over 14 years. Methodology: Retrospective cross-sectional study of 4494 patients under 18 years of age with CHD undergoing cardiac surgery (2010-2024) at the Instituto Nacional de Cardiología “Ignacio Chávez,” using Registro Nacional de Cirugía Cardíaca Pediátrica y Cardiopatías Congénitas (RENACCAPE) data. Comparisons used χ 2 , Fisher's exact, and Mann–Whitney U tests ( P < .05). Analysis was univariate; RACHS-1/STAT scores were incompletely recorded and excluded from risk adjustment. Results: Among 4494 patients (53.5% [2405/4494] male), the predominant age groups were children 1 to 12 years (56.1% [2521/4494]), infants 1 to 11 months (19.8% [888/4494]), adolescents (17.4% [784/4494]), and neonates (6.7% [301/4494]). Down syndrome (6.2% [277/4494]) and DiGeorge syndrome (1.2% [55/4494]) were the most frequent genetic comorbidities; 85.5% (3844/4494) underwent elective surgery. Leading procedures included ventricular septal defect closure (13.6%; [611/4494] mortality 1.8% [11/611]), modified Blalock–Taussig-Thomas shunt (9.8% [440/4494]; mortality 11.1% [49/440]), total anomalous pulmonary venous connection repair (7.4% [334/4494]; mortality 8.4% [28/334]), atrial septal defect closure (6.7% [303/4494]; mortality 0.0%), and tetralogy of Fallot repair (5.9% [267/4494]; mortality 7.9% [21/267]). Norwood had the highest procedure-specific mortality (71.4% [5/7]), followed by Damus–Kaye–Stansel (60.0%) and Jatene (26.0% [32/123]). Overall mortality was 9.4% (421/4494), declining from 10.5% (2010) to 7.1% (2024), with a transient rise during COVID-19. Mortality-associated variables included neonatal/infant age, low weight, cyanotic CHD, genetic syndromes, prolonged cardiopulmonary bypass (147 vs 89 min), longer aortic cross-clamp time (83 vs 54 min), and urgent surgery (all P < .001). Conclusions: To our knowledge this is this largest single-center Mexican pediatric CHD series, in-hospital mortality was 9.4% with a declining trend. Procedure-specific mortalities exceeded STS benchmarks, identifying targets for quality improvement. Expanding RENACCAPE and strengthening referral networks remain priorities.