German Heart Centre Munich—45 years of surgery in adults with congenital heart defects: from primary corrections of septal defects and coarctation to complex reoperations

Abstract

Background: Our historical overview in the form of a cohort study aimed to describe the changes in the cardiac operations in adults with congenital heart disease (ACHD), over 45 years in the German Heart Centre in Munich. Methods:The study population comprised all consecutive patients aged 18 or more, who underwent surgery for congenital heart disease (CHD) at the German Heart Centre Munich, between 1974 and 2018.Operations were coded according to the Adult Congenital Heart Surgery (ACHS) score. Two-tailed chisquare test was used for testing on differences in the frequency of procedural groups between the decades.Results: During the examined 45-year period, 2,882 operations were performed on ACHD. The number of operations per year increased with a correlation coefficient r=0.533, P<0.001. Overall operative mortality was 3.2%. There was no significant difference in mortality over the decades. The percentage of primary CHD diagnosis being the indication for the operation was 99% in the 1970s and decreased significantly to 56% in the 2010s, P<0.001. There was a significant decrease in the relative frequency of atrial septal defect closures from 45% in the 1970s and 1980s to 9% in 2010s (P<0.001). Coarctation repair made up 15% of all operations in the 1970s, then dropped significantly to 1% in the 2010s (P<0.001). The percentage of reoperations increased significantly from 7% in the 1970s to 50% in 2010s (P<0.001). Conclusions:The spectrum of cardiac surgery in ACHD changed significantly over the last 45 years, from primary repair of septal defects and coarctation of the aorta in the 1970s to complex reoperations in the 2010s.

Simultaneous Aortic and Pulmonary Valve Replacement in Repaired Congenital Heart Disease

“…Simultaneous aortic and pulmonary valve replacement in CHD Due to advances in the field of congenital heart disease, the number of adult patients living with congenital heart defects (ACHD) is steadily increasing. While primary correction of congenital heart defects in adults is rare, valve-related reoperations are on the rise in this patient population and currently account for more than half of all surgeries in ACHD patients [1,2]. The most typical valve reoperation is pulmonary valve replacement following reconstruction of right ventricular outflow tract (RVOT) for correction of conotruncal defects, or Ross surgery.…”

“…While primary correction of congenital heart defects in adults is rare, valve-related reoperations are on the rise in this patient population and currently account for more than half of all surgeries in ACHD patients. 1 2 The most typical valve reoperation is pulmonary valve replacement following the reconstruction of the right ventricular outflow tract (RVOT) for the correction of conotruncal defects, or Ross surgery. However, heart defect-dependent or operation-typical enlargement of the aortic root with progressive aortic regurgitation often occurs in these patients, necessitating reoperation of both outlet valves in adulthood.…”