Adult congenital heart disease: experience with the surgical approach

Abstract

Objective: To report the institution experience with the surgical treatment of adults with congenital heart disease due to the increasing number of these patients and the need for a better discussion of the subject.Methods: Retrospective analysis describing demographic data, risk factors and results.Results: 191 patients between 16 and 74 years old were operated on. Primary correction was done in 171 cases, 93 (55%) for atrial septal defect repair. Among 20 (12%) reoperations, pulmonary valve replacement was done in six cases. The mean intensive care and hospital stay were 2.7 and 8.5 days respectively, significantly greater for the reoperated cases (P=0.001). The mean bypass and clamping times were 68.6 and 44.7 minutes respectively, greater for the reoperated cases (P<0.0001 and P=0.0003 respectively). Hospital mortality was 4.2% and male sex, functional class III-IV and older age at operation were predictive risk factors. Significant complications were more frequent in the reoperated cases (P<0.003), mainly atrial flutter and fibrillation. Among 183 patients discharged, 149 (82%) are being followed and atrial flutter and fibrillation are common. The mean functional class value improved significantly after operation (1.66 to 1.11; P<0.0001). The estimated survival was 96.2% in six years. Conclusion:Heart surgery in adults with congenital heart disease can be accomplished with low mortality and functional class improvement. Immediate and late complications are frequent. Multicenter studies are important to better characterize this patient population in the country.Descriptors: Heart defects, congenital. Adult. Cardiac surgical procedures.Resumo Objetivo: Relatar a experiência da instituição com o tratamento cirúrgico de adultos com cardiopatia congênita devido ao crescente aumento no número desses pacientes e consequentes necessidades de maior discussão do tema.Métodos: Análise retrospectiva dos pacientes operados, com análise de dados demográficos, fatores de risco e resultados.Resultados: Cento e noventa e um pacientes, com idade entre 16 e 74 anos, foram operados. Cirurgia primária foi realizada em 171 pacientes, 93 (55%) com comunicação interatrial. Dentre 20 (12%) reoperações, substituição de valva pulmonar ocorreu em seis casos. Os tempos médios de unidade de terapia intensiva e hospitalar foram 2,7 e 8,5 dias, respectivamente, maiores nas reoperações (P=0,001). Os tempos médios de cir- 372Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(3):371-9Amaral FTV, et al. -Adult congenital heart disease: experience with the surgical approach city area (n=40, 20%) or in the region (n=133, 70%) while 17 (10%) were referred from other states. An Excel data base was created containing general information of the patients, possible preoperative risk factors such as diabetes, cyanosis, smoking, systemic hypertension, obesity and chronic lung disease, detailed information regarding the surgical procedure, hospital complications and follow up information.The preoperative data collec...

Nineteen Years of Adult Congenital Heart Surgery in a Single Center

“…New York Heart Association functional class III or higher has also been identified earlier as a risk factor for postoperative adverse events 15,21,32 and mortality. 7,15,31 However, not all studies 21,31 could confirm this association in multivariate analyses. In contrast to the study by Kogon et al, 15 RACHS-1 category three or above was associated with adverse outcomes.…”

“…This study reports the need for cardiac surgery in a population-based cohort of adult patients with congenital heart disease unaffected by referral patterns, unlike the majority of previous studies. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] We found an average of 29 surgeries annually in adults, corresponding to 10/year per million inhabitants. For comparison, the average number of cardiac surgeries in children (under 18 years) in our center was 123/year corresponding to 44/million inhabitants.…”

Recommendations for starting a grown up congenital heart disease (GUCH) unit

“…In the more experienced institutions, with an important number of complex CHD cases already treated, admission is common due to reoperations [ 28 ] and arrhythmias [ 32 ] . Also frequent are admissions for interventional catheterization and primary surgery in adults [ 33 , 34 ] . Other less frequent causes of admission are endocarditis and high risk pregnancy, which demands specialized obstetrical care [ 18 ] .…”

“…Knowledge of the interventions long term results is crucial for improving therapeutic methods and strategies. Due to the great variety of diagnostic and clinical features in GUCH patients the relevance of multicentre studies has been emphasized in the international literature [ 34 ] and gathering informations from several centers are needed. The construction of a national database, quite possible in an era of great advances regarding information storage should be an accomplishment to be reached.…”

“…It is interesting to mention that, as far as we know, in the last 16 years, only ten papers were published in indexed Brazilian journals regarding CHD in adults [ 16 , 34 , 36 - 43 ] . However, a change in this perspective is soon expected.…”