Abstract 16378: Adult Congenital Heart Disease Lesions Commonly Repaired at High-Quality Surgical Centers in Limited-Resource Settings Have Similar Outcomes as Pediatric Repairs

Abstract

Introduction: Improved medical and surgical therapies have increased attention to congenital heart disease (CHD) across the lifespan. There are limited data on the global burden of adult CHD, which could guide treatment and program development in limited-resource settings. Methods: We analyzed all CHD surgeries from 2015-2020 at 33 programs in 16 countries, using audited data from the International Quality Improvement Collaborative for CHD. Demographic characteristics and outcomes (in-hospital mortality, major infection, and length of ICU stay) were compared for procedures with >100 cases in patients ≥18 years. Adult and pediatric CHD outcomes were compared. Results: Five procedures each contributed >100 cases, accounting for 56% of all adult CHD cases: atrial septal defect closure (ASD; 1061 cases), ventricular septal defect closure (VSD; 350 cases), tricuspid valvuloplasty (TV; 179 cases), tetralogy of Fallot repair (TOF; 141 cases), and pulmonary valve replacement (PVR; 118 cases). The distribution of adult CHD cases was relatively consistent from 2015-2020 (Figure 1A). Median age at surgery was 36 years (IQR 26-48) for ASD, 30 (23-41) for VSD, 39 (28-51) for TV, 26 (21-31) for TOF, and 23 (20-30) for PVR. Median BMI for TOF was 18.9 (IQR 16.7-21.4) compared to 21-22 for the other procedures. In-hospital mortality and major infection were higher for adult TOF (5.0% and 7.9%, respectively) and PVR (4.2%, 3.4%) compared to VSD (0.9%, 2.3%), TV (0.6%, 2.2%), and ASD (0.1%, 0.9%). Median duration of ICU stay was longer for TOF and PVR (77 and 72 hours, respectively) compared with the other procedures (41-48 hours). There was no significant difference in mortality or major infection between adult and pediatric patients for each procedure (Figure 1B). Conclusions: ASD, VSD, TOF, TV, and PVR are the most common adult CHD procedures at IQIC sites, accounting for over half of all adult cases. Adverse outcomes are low and similar among adult and pediatric patients.