Achievements in Congenital Heart Defect Surgery

Abstract

Background— This article presents an update of the results achieved by modern surgery in congenital heart defects (CHDs) over the past 40 years regarding survival and the need for reoperations, especially focusing on the results from the past 2 decades. Methods and Results— From 1971 to 2011, all 7038 patients <16 years of age undergoing surgical treatment for CHD at Rikshospitalet (Oslo, Norway) were enrolled prospectively. CHD diagnosis, date, and type of all operations were recorded, as was all-cause mortality until December 31, 2012. CHDs were classified as simple (3751/7038=53.2%), complex (2918/7038=41.5%), or miscellaneous (369/7037=5.2%). Parallel to a marked, sequential increase in operations for complex defects, median age at first operation decreased from 1.6 years in 1971 to 1979 to 0.19 years in 2000 to 2011. In total, 1033 died before January 1, 2013. Cumulative survival until 16 years of age in complex CHD operated on in 1971 to 1989 versus 1990 to 2011 was 62.4% versus 86.9% ( P <0.0001). In the comparison of patients operated on in 2000 to 2004 versus 2005 to 2011, 1-year survival was 90.7% versus 96.5% ( P =0.003), and 5-year cumulative survival was 88.8% versus 95.0% ( P =0.0003). In simple versus complex defects, 434 (11.6%) versus 985 (33.8%) patients needed at least 1 reoperation before 16 years of age. In complex defects, 5-year cumulative freedom of reoperation among patients operated on in 1990 to 1999 versus 2000 to 2011 was 66% versus 73% ( P =0.0001). Conclusions— Highly significant, sequential improvements in survival and reductions in reoperations after CHD surgery were seen. A future challenge is to find methods to reduce the need for reoperations and further reduce long-term mortality.

Trends in Congenital Heart Disease

“…On the other end of the spectrum of disease severity, outcomes continue to improve in patients with more complex lesions ( Figure 1). 8 Survival through childhood is now common even in the most complex and lethal malformations, such as hypoplastic left heart syndrome. 9 However, as the dramatic early benefits of cardiac intervention and surgical repair in childhood have become routine, the sequelae of CHD and its treatments have increasingly emerged in adulthood 10 ( Figure 2).…”

“…Used with permission. Reprinted from Erikssen et al 8 with permission of the publisher. Copyright © 2015, American Heart Association, Inc.…”

Pediatric Cardiac Surgery

“…Raissadati and associates 7 from Helsinki report data pertaining to all patients who underwent pediatric heart surgery during childhood in Finland from 1953 to 2009, and Erikssen and associates 8 from Oslo report data pertaining to nearly all patients who underwent heart surgery during childhood in Norway from 1971 to 2011 (including all patients from 2003-2011). What is most remarkable about these 2 reports is that both groups of investigators were able to use national population registries to obtain recent life status data for >98% of patients.…”

„Überlebende“

“…Auch im Langzeitverlauf bis zum 16. Lebensjahr findet sich bei komplexen Herzfehlbildungen eine deutliche Zunahme des Überlebens von 62 % in den Jahren 1971-1989 auf 87 % in den Jahren 1990-2011 [7]. Daher gehen aktuelle Hochrechnungen davon aus, dass 2017 über 181.000 Erwachsene mit angeborenen Herzfehlern in Deutschland leben werden [3].…”