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Ten-year experience with surgical treatment of adults with congenital cardiac disease

Published online by Cambridge University Press:  06 October 2010

Pierre Wauthy ,
Jacques Massaut ,
Ahmed Sanoussi ,
Hélène Demanet ,
Marielle Morissens ,
Nasroolla Damry ,
Hughes Dessy ,
Sophie G. Malekzadeh-Milani  and
Frank E. Deuvaert
Pierre Wauthy*
Affiliation:
Department of Cardiac Surgery, Brugmann University Hospital, Bruxelles, Belgium
Jacques Massaut
Affiliation:
Department of Intensive Care, Brugmann University Hospital, Bruxelles, Belgium
Ahmed Sanoussi
Affiliation:
Department of Cardiac Surgery, Brugmann University Hospital, Bruxelles, Belgium
Hélène Demanet
Affiliation:
Department of Cardiac Surgery, Brugmann University Hospital, Bruxelles, Belgium
Marielle Morissens
Affiliation:
Department of Cardiology, Brugmann University Hospital, Bruxelles, Belgium
Nasroolla Damry
Affiliation:
Department of Radiology, Brugmann University Hospital, Bruxelles, Belgium
Hughes Dessy
Affiliation:
Department of Paediatric Cardiology, University Childrens Hospital Queen Fabiola, Bruxelles, Belgium
Sophie G. Malekzadeh-Milani
Affiliation:
Department of Paediatric Cardiology, University Childrens Hospital Queen Fabiola, Bruxelles, Belgium
Frank E. Deuvaert
Affiliation:
Department of Cardiac Surgery, Brugmann University Hospital, Bruxelles, Belgium
*
Correspondence to: Pr. P. Wauthy, Service de Chirurgie Cardiaque, CHU Brugmann, 4 Place Arthur van Gehuchten, 1020 Bruxelles, Belgique. Tel: +32 2 477 39 95; Fax: +32 477 21 61; E-mail: [email protected]
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Abstract

The number of adults with congenital cardiac disease continues to increase, and adult patients are now more numerous than paediatric patients. We sought to identify risk factors for perioperative death and report our results with surgical management of adult patients with congenital cardiac disease. We retrospectively analysed in-hospital data for 244 consecutive adult patients who underwent surgical treatment of congenital cardiac disease in our centre between January, 1998 and December, 2007. The mean patient age was 27.2 plus or minus 11.9 years, 29% were in functional class III or IV, and 25% were cyanosed. Of the patients, half were operated on for the first time. A total of 61% of patients underwent curative operations, 36% a reoperation after curative treatment, and 3% a palliative operation. Overall mortality was 4.9%. Predictive factors for hospital death were functional class, cyanosis, non-sinus rhythm, a history of only palliative previous operation(s), and an indication for palliative treatment. Functional class, cyanosis, type of initial congenital cardiac disease (single ventricle and double-outlet right ventricle), and only palliative previous operation were risk factors for prolonged intensive care stay (more than 48 hours). The surgical management of adult patients with congenital cardiac disease has improved during recent decades. These generally young patients, with a complex pathology, today present a low post-operative morbidity and mortality. Patients having undergone palliative surgery and reaching adulthood without curative treatment present with an increased risk of morbidity and mortality. Univentricular hearts and double-outlet right ventricles were associated with the highest morbidity.

Keywords

Adultarrhythmiareoperationsoutcomesimaging
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 1 , February 2011 , pp. 39 - 45
Copyright
Copyright © Cambridge University Press 2010

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References

1. Warnes, CA, Liberthson, R, Danielson, GK, et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001; 37: 1170–1175.CrossRefGoogle ScholarPubMed
2. Klcovansky, J, Sondergaard, L, Helvind, M, Andersen, HO. Cardiac surgery in grown-up congenital heart patients. Will the surgical workload increase? Interact Cardiovasc Thorac Surg 2008; 7: 84–89.CrossRefGoogle ScholarPubMed
3. Srinathan, SK, Bonser, RS, Sethia, B, Thorne, SA, Brawn, WJ, Barron, DJ. Changing practice of cardiac surgery in adult patients with congenital heart disease. Heart 2005; 91: 207–212.CrossRefGoogle ScholarPubMed
4. Bhat, AH, Sahn, DJ. Congenital heart disease never goes away, even when it has been ‘treated’: the adult with congenital heart disease. Curr Opin Pediatr 2004; 16: 500–507.CrossRefGoogle ScholarPubMed
5. Marelli, AJ, Mackie, AS, Ionescu-Ittu, R, Rahme, E, Pilote, L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007; 115: 163–172.CrossRefGoogle ScholarPubMed
6. Somerville, J. The fruits of our labors. Particularly Denton Cooley’s. Tex Heart Inst J 1994; 21: 257–260.Google ScholarPubMed
7. Warnes, CA. The adult with congenital heart disease: born to be bad? J Am Coll Cardiol 2005; 46: 1–8.CrossRefGoogle ScholarPubMed
8. Gatzoulis, MA, Hechter, S, Siu, SC, Webb, GD. Outpatient clinics for adults with congenital heart disease: increasing workload and evolving patterns of referral. Heart 1999; 81: 57–61.CrossRefGoogle ScholarPubMed
9. Webb, GD. Care of adults with congenital heart disease – a challenge for the new millennium. Thorac Cardiovasc Surg 2001; 49: 30–34.CrossRefGoogle ScholarPubMed
10. Dearani, JA, Connolly, HM, Martinez, R, Fontanet, H, Webb, GD. Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond. Cardiol Young 2007; 17 (Suppl 2): 87–96.CrossRefGoogle Scholar
11. Report of the British Cardiac Society Working Party. Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK. Heart 2002; 88: i1–i14.CrossRefGoogle Scholar
12. Crossland, DS, Jackson, SP, Lyall, R, Burn, J, O’Sullivan, JJ. Employment and advice regarding careers for adults with congenital heart disease. Cardiol Young 2005; 15: 391–395.CrossRefGoogle ScholarPubMed
13. Immer, FF, Althaus, SM, Berdat, PA, Saner, H, Carrel, TP. Quality of life and specific problems after cardiac surgery in adolescents and adults with congenital heart diseases. Eur J Cardiovasc Prev Rehabil 2005; 12: 138–143.CrossRefGoogle ScholarPubMed
14. Maruszewski, B, Lacour-Gayet, F, Monro, JL, Keogh, BE, Tobota, Z, Kansy, A. An attempt at data verification in the EACTS Congenital Database. Eur J Cardiothorac Surg 2005; 28: 400–404.CrossRefGoogle ScholarPubMed
15. Maruszewski, B, Tobota, Z. The European Congenital Heart Defects Surgery Database experience: Pediatric European Cardiothoracic Surgical Registry of the European Association for Cardio-Thoracic Surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 143–147.CrossRefGoogle ScholarPubMed
16. Stellin, G, Vida, VL, Padalino, MA, Rizzoli, G. Surgical outcome for congenital heart malformations in the adult age: a multicentric European study. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 95–101.CrossRefGoogle ScholarPubMed
17. Karamlou, T, Diggs, BS, Person, T, Ungerleider, RM, Welke, KF. National practice patterns for management of adult congenital heart disease: operation by pediatric heart surgeons decreases in-hospital death. Circulation 2008; 118: 2345–2352.CrossRefGoogle ScholarPubMed
18. Berdat, PA, Immer, F, Pfammatter, JP, Carrel, T. Reoperations in adults with congenital heart disease: analysis of early outcome. Int J Cardiol 2004; 93: 239–245.CrossRefGoogle ScholarPubMed
19. Vida, VL, Berggren, H, Brawn, WJ, et al. Risk of surgery for congenital heart disease in the adult: a multicentered European study. Ann Thorac Surg 2007; 83: 161–168.CrossRefGoogle ScholarPubMed
20. Dore, A, Glancy, DL, Stone, S, Menashe, VD, Somerville, J. Cardiac surgery for grown-up congenital heart patients: survey of 307 consecutive operations from 1991 to 1994. Am J Cardiol 1997; 80: 906–913.CrossRefGoogle ScholarPubMed
21. Monro, J. The changing state of surgery for adult congenital heart disease. Heart 2005; 91: 139–140.CrossRefGoogle ScholarPubMed
22. Jacobs, JP, Lacour-Gayet, FG, Jacobs, ML, et al. Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results. Ann Thorac Surg 2005; 79: 1635–1649.CrossRefGoogle ScholarPubMed
23. Jacobs, JP, Ungerleider, RM, Tchervenkov, CI, et al. Opinions from the audience response survey at the first joint meeting of the Congenital Heart Surgeons’ Society and the European Congenital Heart Surgeons Association. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 8: 198–217.CrossRefGoogle Scholar
24. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.CrossRefGoogle Scholar
25. Walsh, EP, Cecchin, F. Arrhythmias in adult patients with congenital heart disease. Circulation 2007; 115: 534–545.CrossRefGoogle ScholarPubMed
26. Williams, WG, Webb, GD. The emerging adult population with congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2000; 3: 227–233.CrossRefGoogle ScholarPubMed
27. Rey, C. The best of congenital heart disease in 2006. Arch Mal Coeur Vaiss 2007; 100: 103–110.Google ScholarPubMed