Morbidity and Mortality Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiac Reoperations

Giamberti, Alessandro; Chessa, Massimo; Abella, Raúl; Butera, Gianfranco; Carlucci, Concetta; Nuri, Halkawt; Frigiola, Alessandro; Ranucci, Marco

doi:10.1016/j.athoracsur.2009.05.060

Cited by 84 publications

(64 citation statements)

References 16 publications

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“…The overall perioperative mortality was 3.4% in our study, which is comparable to the mortality rates reported previously. 5,26,27 The mortality rate was low for corrective surgery but high for palliative surgery, which is also in agreement with current literature. 5,27 Even after adjustment for childhood operations, defect, and multiple defects, male patients with congenital heart disease had more surgery in adulthood than female patients for both first-time surgery and reoperation.…”

Section: Discussionsupporting

confidence: 80%

Surgery in Adults With Congenital Heart Disease

et al. 2011

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Background-A significant proportion of patients with congenital heart disease require surgery in adulthood. We aimed to give an overview of the prevalence, distribution, and outcome of cardiovascular surgery for congenital heart disease. We specifically questioned whether the effects of surgical treatment on subsequent long-term survival depend on sex. Methods and Results-From the Dutch Congenital Corvitia (CONCOR) registry for adults with congenital heart disease, we identified 10 300 patients; their median age was 33.1 years. Logistic and Cox regression models were used to assess the association of surgery in adulthood with sex and with long-term survival. In total, 2015 patients (20%) underwent surgery for congenital heart disease in adulthood during a median follow-up period of 15.1 years; in 812 patients (40%), it was a reoperation. Overall, both first operations and reoperations in adulthood were performed significantly more often in men compared with women (adjusted odds ratioϭ1.4 [95% confidence interval, 1.2-1.6] and 1.2 [95% confidence interval, 1.0 -1.4], respectively). Patients with their third and fourth or more surgery in adulthood had a 2-and 3-times-higher risk of death compared with patients never operated on (adjusted hazard ratioϭ1.9 [95% confidence interval, 1.0 -3.6] and 2.7 [95% confidence interval, 1.1-6.3], respectively). Men with a reoperation in adulthood had a 2-times-higher risk of death than women (adjusted hazard ratioϭ1.9; 95% confidence interval, 1.0 -3.5). Conclusions-Of predominantly young adults with congenital heart disease, one fifth required cardiovascular surgery during a 15-year period; in 40%, the surgery was a reoperation. Men with congenital heart disease have a higher chance of undergoing surgery in adulthood and have a consistently worse long-term survival after reoperations in adulthood compared with women. (Circulation. 2011;124:2195-2201.)

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Section: Discussionsupporting

confidence: 80%

Surgery in Adults With Congenital Heart Disease

et al. 2011

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“…Particularly regarding the age at operation, we found it difficult to establish a number above what the surgical risk should be considered high. Also, known risk factors as pulmonary hypertension [13] and increased CPB time [21,22] had only a tendency for statistical significance in our data.…”

Section: Immediate Resultscontrasting

confidence: 37%

“…It should be remembered that the number of reoperated patients was small (n=20) with no early mortality despite the fact that they have required a prolonged time of CPB, CLAMP and intensive care stay. It is well known the fact that reoperations are more demanding and have a significant morbidity, albeit low mortality can be accomplished when the procedure is done in centers dedicated to adult congenital heart disease treatment [22].…”

Section: Immediate Resultsmentioning

confidence: 99%

Adult congenital heart disease: experience with the surgical approach

Amaral

Rodrigues

Manso

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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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...

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“…Although no surgically induced heart block developed in patients in our study, manipulating the annulus does carry a nonnegligible risk of heart block, particularly with valve replacement [9]. In addition, our group and others have previously shown that performing concomitant procedures and prolonged cardiopulmonary bypass time in the setting of adult congenital heart operations is correlated with increased morbidity and prolonged lengths of stay [10,11].…”

Section: Functional Tricuspid Regurgitation In Right-sided Heart Diseasementioning

confidence: 87%