Validation of the grown-ups with congenital heart disease score

Hörer, Jürgen; Roussin, Régine; LeBret, Emanuel; Ly, Mohamed; Abdullah, Jarrah; Marzullo, Rafaella; Ohain, Jelena Pabst von; Belli, Emrè

doi:10.1136/heartjnl-2017-312275

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…The problem of acquired heart disease in ACHD is still to come. The proportion of the reoperations stayed on the level of 2000s, constituting 51% of all operations, which is consistent with current reports of other specialised centres (30). However, the proportion of the 4 th + reoperations raised significantly to 15% of all reoperations.…”

Section: Discussionsupporting

confidence: 89%

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

Ohain

Tonino

Kaemmerer

et al. 2021

Cardiovasc Diagn Ther

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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.

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Section: Discussionsupporting

confidence: 89%

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

Ohain

Tonino

Kaemmerer

et al. 2021

Cardiovasc Diagn Ther

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“…Hospital mortality following congenital heart surgery in adults may be higher than in the pediatric population (96). Early mortality following cardiac surgery in ACHD is reported to range from 1.8% to 3.6% (13,40,97,98), while up to 10% of the patients exhibit at least one major complication postoperatively (3). Hence, there is a need for risk stratification models that accurately predict mortality and morbidity following surgery in ACHD, in addition to a patient-reported outcome tool (99).…”

Section: Quality Assessment and Outcome Predictionmentioning

confidence: 99%

“…Therefore, the spectrum of surgery in ACHD has shifted from primary repair to the treatment of residual defects or sequelae of the initial pathology or previous treatment. As a consequence, since the year 2000, more than half of all operations performed on ACHD require repeat sternotomy (3). Moreover, patients with shunts on the atrial level, who did not undergo closure during childhood, are now often eligible for shunt closure with the use of catheter-based techniques (4).…”

Section: Introductionmentioning

confidence: 99%

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Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Hörer

2018

Cardiovasc. Diagn. Ther

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Today, more than two thirds of patients with congenital heart disease (CHD) are adults. Cardiac surgery plays an essential role in restoring and maintaining cardiac function, aside from evolving medical treatment and catheter-based interventions. The aim of the present publication was to describe the spectrum of operations performed on adults with CHD (ACHD) by reviewing current literature. Currently, surgery for ACHD is predominantly valve surgery, since valvular pathologies are often either a part of the basic heart defect or develop as sequelae of corrective or palliative surgery. Surgical techniques for valve repair, established in patients with acquired heart disease (non-ACHD), can often be transferred to ACHD. New valve substitutes may help to reduce the number of redo operations. Most of valve operations yield good results in terms of survival and quality of life, with the precondition that the ventricular function is preserved. Heart failure due to end-stage CHD is the most frequent cause of mortality in ACHD. However, surgical treatment by means of mechanical circulatory support (MCS) is still uncommon and the mortality exceeds the one following other operations in ACHD. Currently, different devices are used and new technical developments are in progress. However, there still is no ideal assist device available. Therefore, heart transplantation remains the only valid option for end-stage CHD. Despite higher early mortality following heart transplantation in ACHD compared to non-ACHD, the long-term survival compares favorably to non-ACHD. There is room for improvement by refining the indications, the time of listing, and the perioperative care of ACHD transplant patients. Sudden death is the second most frequent cause of mortality in ACHD. Ventricular tachycardia is the most frequent cause of sudden death followed by coronary artery anomaly. Due to the increasing awareness of physicians and the improved imaging techniques, coronary artery anomalies are coming more into the focus of cardiac surgeons. However, the reported experience is limited and it is currently difficult to provide a standardized and generally applicable recommendation for the indication and the adequate surgical technique. With the increasing age and complexity of ACHD, treatment of rhythm disturbances by surgical ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation and resynchronisation gains importance. A risk score specifically designed for surgery in ACHD is among the newest developments in predicting the outcome of surgical treatment of ACHD. This evidence-based score, derived from and validated with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database, enables comparison of risk-adjusted performance of the whole spectrum of procedures performed in ACHD and helps in understanding the differences in surgical outcomes. The score is thus a powerful tool for quality control and quality improvement. In conclusion, new developments in surgery for ACHD are currently made with regard to ...

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“…Despite improvements in survival and quality of life, patients with complex CHD are not typically cured of their disease and tend to develop specific CHD comorbidities that must be taken into account when further cardiac surgery in adulthood is required. The median age of adult patients undergoing congenital heart surgery ranges from 26 to 37 years 4,5 . Cardiac procedures for adult CHD account for 10% and 20% of all cardiac CHD surgeries in the United States and countries with universal health care, respectively.…”

Section: Introductionmentioning

confidence: 99%

Adult congenital heart disease and anesthesia: An educational review

Lei

Heggie

2020

Pediatric Anesthesia

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Prognosis has dramatically improved among children with congenital heart disease (CHD), and the median survival for severe CHD is currently 25 years (ie, into adulthood). However, additional cardiac surgeries are often necessary in adults with CHD, whose unique cardiovascular anatomy and physiology necessitate specialized management by experts in adult CHD (ACHD) during the perioperative period. ACHD is characterized by a combination of congenital cardiac lesions, intervention‐related anomalies that have developed over time, comorbidities caused by long‐standing CHD, and comorbidities related to various syndromes and lifestyle factors. The present educational review discusses the transition from pediatric to adult cardiac care, comorbidities that develop as a result of ACHD, the assessments necessary for patients with ACHD prior to both cardiac and noncardiac surgeries, and the key ACHD lesions relevant to perioperative management.

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Validation of the grown-ups with congenital heart disease score

Abstract: We could confirm the good predictive power of the GUCH mortality score for postoperative mortality in a large population of adults with congenital heart disease.

Cited by 17 publications

References 23 publications

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

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

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Adult congenital heart disease and anesthesia: An educational review

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