Congenital Heart Disease
Cardiac Surgery for Grown-Up Congenital Heart Patients: Survey of 307 Consecutive Operations from 1991 to 1994

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Abstract

The cardiac surgery performed from 1991 to 1994 in a unit dedicated specifically for grown-up congenital heart (GUCH) patients was reviewed to determine the frequency of various procedures, incidence of first and reoperations, early mortality, and its determinants. The 295 patients, aged 16 to 77 years (31 ± 13), had 307 operations. First operations (n = 128, 42%) were most commonly for closure of atrial septal defect (n = 40), aortic valve replacement (n = 31) or repair of aortic coarctation (n = 14). Reoperations were more frequent (n = 179, 58%) and divided among first corrective repair (n = 49), reoperation after corrective repair (n = 115), and further palliation (n = 15). First corrective surgery was mainly for aortic valve disease (n = 17), Fallot (n = 7), and lesions needing a Fontan procedure (n = 5). Reoperations after corrective repair were needed for aortic valve disease (n = 43), right-sided conduit (n = 30), or recoarctation (n = 11). Early mortality was influenced by presence of central cyanosis (9 of 49, 18% in cyanotic patients; 12 of 258, 5% in acyanotic; p <0.001), increased number of previous operations (0 = 4%, 1 = 7%, 2 = 11%, >2 = 13%; p = 0.003), and increasing age of patients. Cyanotic patients had more serious postoperative complications: pleural and pericardial effusions, severe bleeding, renal insufficiency, and sepsis, and their hospital stay was longer compared with acyanotic patients (20 ± 17 vs 11 ± 8 days; p <0.001). In GUCH patients, reoperations cause the largest demand on cardiac surgical services. Increased survival of patients with complex cardiovascular malformations brings difficult challenges not only to cardiologists but also to cardiovascular surgeons. There is a need to provide continued highly specialized care. Resources, patients, and funding should be concentrated in a few designated centers.

Section snippets

Methods

From the database of the Royal Brompton Hospital’s GUCH Unit, which has maintained accurate records of all admissions of adolescents and adults with congenital heart disease since 1980, patients aged ≥16 years (adult by definition in the United Kingdom) who had cardiovascular surgery between January 1991 and December 1994 were identified. All individual patients’ records were examined and data were collated on those who had surgery for congenital heart disease. A first cardiovascular operation

Results

In the 4-year study period, 295 patients (163 men) had 307 operations; 10 had 2 operations and 1 had 3 surgical procedures for aortic valve and ascending aorta complications following endocarditis. Three cardiac surgeons with specific skills in congenital heart disease performed 85% of the operations (38%, 26%, and 21% respectively) and the remaining procedures (mainly aortic valve replacement and closure of atrial septal defect) were performed by 3 cardiac surgeons with no specific training in

Discussion

Many studies have analyzed surgical outcomes in adults with congenital malformations,3, 4, 7, 8, 9, 14but the overall demand and implications of cardiovascular surgery in GUCH patients have not received attention. Schaff and Danielson[17]reviewed, 10 years ago, the Mayo Clinic’s experience with cardiac operations in adults with congenital malformations. More recently, Redington et al[18]reported their experience at the Royal Brompton Hospital, but they underestimated the true data because it

Acknowledgements

We thank Donald E. Mercante, Associate Professor of Biometry, Louisiana State University Medical Center, New Orleans, for statistical support.

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