Congenital heart disease associated with congenital diaphragmatic hernia: A systematic review on incidence, prenatal diagnosis, management, and outcome

Purpose: The purpose of this study was to evaluate the impact of congenital heart disease (CHD)on infants with congenital diaphragmatic hernia (CDH). Methods: Using a defined search strategy (PubMed, Cochrane, Embase, Web of Science MeSH headings), we searched studies reporting the incidence, management, and outcome of CDH infants born with associated CHD. Results: Of 6410 abstracts, 117 met criteria. Overall, out of 28,974 babies with CDH, 4427 (15%)had CHD, of which 42% were critical. CDH repair was performed in a lower proportion of infants with CHD (72%)than in those without (85%; p < 0.0001). Compared to CDH babies without CHD, those born with a cardiac lesion were more likely to have a patch repair (45% vs. 30%; p < 0.01)and less likely to undergo minimally invasive surgery (5% vs. 17%; p < 0.0001). CDH babies with CHD had a lower survival rate than those without CHD (52 vs. 73%; p < 0.001). Survival was even lower (32%)in babies with critical CHD. Conclusion: CHD has a strong impact on the management and outcome of infants with CDH. The combination of CDH and CHD results in lower survival than those without CHD or an isolated cardiac defect. Further studies are needed to address some specific aspects of the management of this fragile CDH cohort. Type of study: Systematic review and meta-analysis. Level of evidence: Level III.