Determinants of Early Mortality After Congenital Heart Surgery: A 7-Year Single-center Experience in Saudi Arabia.

Objectives: To determine predictors of early mortality among pediatric patients undergoing congenital heart surgery at a tertiary care center in Saudi Arabia. Methods: This retrospective cohort study included 955 pediatric patients who underwent congenital heart surgery at King Abdulaziz University Hospital, Jeddah, between January 2017 and December 2023. Demographic, clinical, operative, and postoperative variables were collected. Results: Overall mortality was 4.9%. Mortality was higher among neonates and infants and among patients with RACHS categories 4-6. Non-survivors had longer cardiopulmonary bypass times and more frequent delayed chest closure. Postoperative complications, including the need for extracorporeal membrane oxygenation (ECMO), depressed cardiac function, acute kidney injury, central nervous system (CNS) insult, infection, and prolonged mechanical ventilation and intensive care unit (ICU) stay, were strongly associated with mortality. In multivariate analysis, independent predictors of mortality were prolonged ICU stay, longer postoperative mechanical ventilation, postoperative ECMO support, and postoperative CNS insult. Conclusion: Early mortality was comparable to international benchmarks. Postoperative physiological deterioration, particularly ECMO requirement, neurological injury, prolonged ventilation, and extended ICU stay, was independently associated with death, underscoring the importance of early detection and targeted perioperative management.