Adult congenital heart diseases: experience from a reference center

Abstract

Introduction Adult congenital heart disease (ACHD) represents a growing population in many cardiac centers and it's a challenge for all physicians involved. Multidisciplinary teams integrated by cardiologists, echocardiographers, cardiac surgeons, cardiac anesthesiologists, radiologists and others, have been created in many hospitals to manage such patients (1). The objective was to describe the adult congenital cardiac population scheduled for cardiac surgery in our reference center. Methods We included all patients scheduled for cardiac surgery with a diagnosis of ACHD from January 2017 to May 2018. A retrospective review of medical records was performed for demographics, type of heart defect, intraoperative management, postoperative evolution, ICU length of stay and outcome at 30 days. Results A total of 1060 patients underwent elective cardiac surgery between the study period. Sixty-six patients (6.22%) had the diagnosis of ACHD. Mean age was 53.5±17 years [range 19 to 85 years], 63.6% were male and mean EuroSCORE II was 1.51 [range 0.5 to 5.41]. Type and number of diagnoses were: bicuspid aortic valve 45 patients, atrial septal defect 12 patients, congenital pulmonary stenosis 2 patients, congenital aortic stenosis 1 patient, sub-aortic membrane 1 patient, right coronary artery anomaly 1 patient, single ventricle 1 patient, tetralogy of Fallot 1 patient, Ebstein's anomaly 1 patient and partial atrioventricular canal defect 1 patient. Eight of the 45 patient with aortic bicuspid valve had associated aortic root aneurysm. All patients were monitored with transesophageal echocardiography (TEE). Twenty-five patients (37.8%) were extubated in the operating room. Nine patients (13.6%) required blood products. Percentage of postoperative complications were: arrhythmias (28.7%), renal dysfunction (15.1%), hemorrhage >500ml at 24h (10.6%), respiratory alterations (7.5 %), neurologic events (4.5%), intubation >24h (4.5%), re-operation (3.03 %) and gastrointestinal problems (1.51%). Mean ICU length of stay was 3.27 days [range 1 to 9 days]. There was no mortality at 30 days. Discussion The incidence of ACHD in this review was low and bicuspid aortic valve was the most common anomaly. Operative cardiac risk and age showed a wide range. In this small sample post-operative complications were lower than reported in the literature (2). As reference center for ACHD now the number of complex cases is increasing mainly by those diagnosed and treated in the childhood and coming for a second or third operation.