Letter to the editor - Congenital cardiac disease and biliary atresia - Not a benign relationship

jpedsurg.org

Connor et al. review the National Surgical Quality Improvement Progam-Pediatric (NSQIP-P) database (2012–22) identifying 854 infants from around the USA undergoing a Kasai portoenterostomy (KPE) with the aim of exploring the effect of any associated congenital heart disease (CHD) [1]. They identified 89(10 %). Compared to non-CHD these infants had a two-fold increase in complications if the CHD was “simple” and a three-fold increase if “complex” and importantly no deaths. The problem is that the data-stream stops conclusively at 30 days and all the real action tends to happen after that.

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Article · Sep 2025 · 1 min read

In brief

This letter critiques a database review examining outcomes in infants with biliary atresia and concurrent congenital heart disease undergoing Kasai portoenterostomy. While the study found increased complications in CHD patients with no 30-day mortality, the author highlights a critical limitation: meaningful outcomes in this population typically emerge beyond the 30-day data capture window.

10% of infants undergoing Kasai portoenterostomy have congenital heart disease (CHD), per NSQIP-P data from 2012-2022.
Simple CHD doubles complication risk post-Kasai; complex CHD triples it compared to non-CHD patients.
No deaths occurred in the CHD cohort within 30 days, but NSQIP-P data cutoff limits long-term outcome assessment.
Critical outcomes in biliary atresia with CHD likely occur beyond the 30-day NSQIP-P surveillance window.
Clinicians should anticipate higher perioperative morbidity when managing Kasai patients with concurrent cardiac anomalies.

Written by the GCMD Library team from the article.

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