RT Journal Article
SR Electronic
T1 Contemporary cardiac surgery for adults with congenital heart disease
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1194
OP 1202
DO 10.1136/heartjnl-2016-310384
VO 103
IS 15
A1 Beurtheret, Sylvain
A1 Tutarel, Oktay
A1 Diller, Gerhard Paul
A1 West, Cathy
A1 Ntalarizou, Evangelia
A1 Resseguier, Noémie
A1 Papaioannou, Vasileios
A1 Jabbour, Richard
A1 Simpkin, Victoria
A1 Bastin, Anthony J
A1 Babu-Narayan, Sonya V
A1 Bonello, Beatrice
A1 Li, Wei
A1 Sethia, ​Babulal
A1 Uemura, Hideki
A1 Gatzoulis, Michael A
A1 Shore, Darryl
YR 2017
UL http://heart.bmj.com/content/103/15/1194.abstract
AB Objective Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery.Methods This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011. Early mortality was the primary outcome measure. Midterm to longer-term survival, cumulative incidence of reoperation, other interventions and/or new-onset arrhythmia were secondary outcome measures. Predictors of early/total mortality were identified.Results Age at surgery was 35±15 years, 53% male, 52.3% were in New York Heart Association (NYHA) class I, 37.2% in class II and 10.4% in class III/IV. Early mortality was 1.77% with independent predictors NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm and female gender. Over a mean follow-up of 2.8±2.6 years, 46 patients died. Baseline predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm and non-elective surgery. The number of sternotomies was not independently associated with neither early nor total mortality. At 10 years, probability of survival was 94%. NYHA class among survivors was significantly improved, compared with baseline.Conclusions Contemporary cardiac surgery for ACHD performed at a single, tertiary reference centre with a multidisciplinary approach is associated with low mortality and improved functional status. Also, our findings emphasise the point that surgery should not be delayed because of reluctance to reoperate only.