Surgery for Adult Patients with Congenital Heart Disease: Results from the European Database.

Vladimiro Vida,Laura Torlai Triglia,Dario Gregori,Francesco Bertelli,Tjark Ebels,Bohdan Maruszewski,Claudia Cattapan,Massimo Padalino,Jurgen Horer,Giovanni Di Salvo,Daniele Bottigliengo,Zdzislaw Tobota,Lucia Zanotto,Giovanni Stellin,Lorenza Zanotto,George Sarris

doi:10.3390/jcm9082493

Abstract

Adults with congenital heart disease (ACHD) represent a growing population. To evaluate frequency, type and outcomes of cardiac surgery in ACHD, we gathered data from the European Congenital Heart Surgeons Association Database of 20,602 adult patients (≥18 years) with a diagnosis of congenital heart disease who underwent cardiac surgery, between January 1997 and December 2017. We demonstrated that overall surgical workload (as absolute frequencies of surgical procedures per year) for this specific subset of patients increased steadily during the study period. The most common procedural groups included septal defects repair (n = 5740, 28%), right-heart lesions repair (n = 5542, 27%) and left-heart lesions repair (n = 4566, 22%); almost one-third of the procedures were re-operations (n = 5509, 27%). When considering the year-by-year relative frequencies of the main procedural groups, we observed a variation of the surgical scenario during the last two decades, characterized by a significant increase over time for right and left-heart lesions repair (p < 0.0001, both); while a significant decrease was seen for septal defects repair (p < 0.0001) and transplant (p = 0.03). Overall hospital mortality was 3% (n = 622/20,602 patients) and was stable over time. An inverse relationship between mortality and the number of patients operated in each center (p < 0.0001) was observed.

Highlights

Advances in pediatric cardiac care have led to surging survival rates for patients with congenital heart disease (CHD)
We report data from the largest series of adult patients with CHD who required surgical treatment hitherto evaluated
We demonstrated a variation of the surgical scenario during the last two decades, characterized by an increase in right and left-heart lesions repairs and a significant decrease in septal defects repair and transplants

Summary

Introduction

Advances in pediatric cardiac care have led to surging survival rates for patients with congenital heart disease (CHD). The number of adults (≥18 years of age) with congenital heart disease (ACHD) has significantly grown over time, reaching in 2010 two thirds of the CHD population [1]. Many patients require repeated cardiac surgery after primary repair in infancy for residual lesions or complications, while other patients with simple CHD, not diagnosed during early infancy, some in the setting of a complex secondary physiology, may require surgical treatment later in life [2]. The aim of this study was to assess the frequency, type and outcomes of cardiac surgery in adults with CHD during the last 20 years, within the European Congenital Heart Surgeons Association (ECHSA). The year-by-year relative frequencies of the most common procedural groups were evaluated

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Conclusion