Congenital heart surgery in adults: An Australian experience of 379 cases

Abstract

Background: Congenital heart disease (CHD) may present for the first time in adult life and may require operative repair. Due to technical advances in CHD surgery, an increasing population of children with CHD are surviving into adult life, some of whom need further surgery for residual or complicating lesions. Little is known about the outcomes of CHD surgery in adult patients. Aim: To assess the frequency, types and outcomes of congenital heart surgery in adults. Methods: Retrospective review of hospital records. Long-term outcome data were obtained by questionnaires and from the State Registry of Births, Deaths and Marriages. Results: From 1982–1995, 379 adults aged 34±16 (range, 16–73) years, comprising 144 males and 235 females, were operated on for CHD. In 328 patients, this was their first operation: closure of atrial septal defect in 212 (64%, secundum type in 180, sinus venosus in 14, primum in 18); closure of a persistent ductus arteriosus in 30; repair of coarctation of the aorta in 30; closure of ventricular septal defects in 17; repair of tetralogy of Fallot in 10, and 29 others. Fifty-one cases were reoperations and included Fontan repair in 8, revision of coarctation of the aorta in 8, and complete repair of pulmonary atresia/ventricular septal defect after earlier palliation in 5 subjects. There were 7 perioperative deaths (2%) within 30 days of surgery. After median follow-up of 8 years, there were 27 late deaths (7%). Most survivors are in functional Class I. Conclusions: Congenital heart disease surgery is often required in adults, both for first operations and redo procedures, many of which are for complex heart disease. Despite this, good perioperative and long-term results may be obtained.