Cardiac surgery in grown-up congenital heart patients. Will the surgical workload increase?

Klcovansky, Jakob; Søndergaard, Lars; Helvind, Morten; Andersen, Henning Haahr

doi:10.1510/icvts.2007.162941

Cited by 14 publications

(11 citation statements)

References 14 publications

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“…(14) had an overall operative mortality of 6.9% in only children over a 25‐year period; Klcovansky et al. (15) had an overall mortality of 1.3% in GUCH over an 8‐year period; and Luciani et al. (16) had an excellent survival rate of 99% in adults with congenital heart disease over a 5‐year period.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

Popov¹,

Coskun²,

Tirilomis³

et al. 2009

Artificial Organs

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Due to improved outcome after surgery for congenital heart defects, children, adolescents, and grown-ups with congenital heart defects become an increasing population. In order to evaluate operative risk and early outcome after mechanical aortic valve replacement (AVR) in this population, we reviewed patients who underwent previous repair of congenital heart defects. Between July 2002 and November 2008, 15 (10 male and 5 female) consecutive patients (mean age 14.5 +/- 10.5 years) underwent mechanical AVR. Hemodynamic indications for AVR were aortic stenosis in four (27%), aortic insufficiency in eight (53%), and mixed disease in three (20%) after previous repair of congenital heart defects. All patients had undergone one or more previous cardiovascular operations due to any congenital heart disease. Concomitant cardiac procedures were performed in all of them. In addition to AVR, in two patients, a mitral valve exchange was performed. One patient received a right ventricle-pulmonary artery conduit replacement as concomitant procedure. The mean size of implanted valves was 23 mm (range 17-29 mm). There were neither early deaths nor late mortality until December 2008. Reoperations were necessary in five (33%) and included implantation of a permanent pacemaker due to complete atrioventricular block in two (15%), mitral valve replacement with a mechanical prosthesis due to moderate to severe mitral regurgitation in one (7%), aortocoronary bypass grafting due to stenosis of a coronary artery in one (7%), and in one (7%), a redo subaortic stenosis resection was performed because of a secondary subaortic stenosis. At the latest clinical evaluation, all patients were in good clinical condition without a pathological increased gradient across the aortic valve prosthesis or paravalvular leakage in echocardiography. Mechanical AVR has excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. Previous operations do not significantly affect postoperative outcome.

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Section: Discussionmentioning

confidence: 99%

Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

Popov¹,

Coskun²,

Tirilomis³

et al. 2009

Artificial Organs

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“…The incidence of CHD is approximately eight per 1000 live-born children, about 85% of these patients are nowadays reported to survive into adulthood [9][10][11][12][13]. The increased survival of patients with CHD can be attributed to improvements in imaging techniques that increased the chances of detecting prenatal and postnatal cardiac anomalies, as well as the optimization of the results of early correction in neonates and infants and advances in pre-and postoperative care, in addition to the widespread screening of asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Adult Patients with Congenital Heart Disease: Results from the European Database

Vida

Zanotto

Triglia

et al. 2020

JCM

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Adults with congenital heart disease (ACHD) represent a growing population. To evaluate frequency, type and outcomes of cardiac surgery in ACHD, we gathered data from the European Congenital Heart Surgeons Association Database of 20,602 adult patients (≥18 years) with a diagnosis of congenital heart disease who underwent cardiac surgery, between January 1997 and December 2017. We demonstrated that overall surgical workload (as absolute frequencies of surgical procedures per year) for this specific subset of patients increased steadily during the study period. The most common procedural groups included septal defects repair (n = 5740, 28%), right-heart lesions repair (n = 5542, 27%) and left-heart lesions repair (n = 4566, 22%); almost one-third of the procedures were re-operations (n = 5509, 27%). When considering the year-by-year relative frequencies of the main procedural groups, we observed a variation of the surgical scenario during the last two decades, characterized by a significant increase over time for right and left-heart lesions repair (p < 0.0001, both); while a significant decrease was seen for septal defects repair (p < 0.0001) and transplant (p = 0.03). Overall hospital mortality was 3% (n = 622/20,602 patients) and was stable over time. An inverse relationship between mortality and the number of patients operated in each center (p < 0.0001) was observed.

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“…By definition, the patient is affected from birth. An estimated 8 of 1000 births present with congenital cardiac disease, [1][2][3] an incidence that appears to be stable across time with little influence from geographic factors. Infant mortality in these patients has fallen in four decades from 80% 6 to less than 10%, 1,3,7 because of the development of the technology required for early diagnosis and improvement in their therapeutic management.…”

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confidence: 99%

“…4,8,10 The therapeutic management of adult patients with congenital cardiac disease is a small subspecialty of cardiology and cardiac surgery. [2][3][4]8 These patients, designated as patients with grown-up congenital cardiac disease by J. Somerville, 11 present with often-complex medical, psychosocial, professional, obstetrical, and surgical problems. [10][11][12][13] They are frequently survivors of (sometimes multiple) operations in childhood but also of unaddressed anomalies discovered later.…”

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confidence: 99%

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

et al. 2010

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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.

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Cardiac surgery in grown-up congenital heart patients. Will the surgical workload increase?

Cited by 14 publications

References 14 publications

Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

Surgery for Adult Patients with Congenital Heart Disease: Results from the European Database

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

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