Background
Due to the advancements in congenital cardiac surgery and interventional cardiology
in the last 5 decades, more than 85% of congenital heart patients now survive to adulthood.
Methods
This retrospective study included 135 Adult Congenital Heart Disease (ACHD) patients,
who had cardiac surgery at Southampton General Hospital over 3 consecutive years.
We also included 42 patients with a structurally normal heart who had cardiac surgery
for acquired cardiac conditions as a control group. Preoperative, intraoperative and
postoperative data were analysed in both groups to identify risk factors for morbidity
and mortality.
Results
In the ACHD group, in hospital mortality was 0.7%. In the control group no deaths
were observed. Fifty-eight per cent of the ACHD patients had significantly higher
perioperative morbidity with arrhythmias (26%), bleeding (3%), prolonged ventilation
(11.3%) and renal replacement therapy 1.5%. In the non ACHD control group 32% (p = 0.003) developed perioperative complications with arrhythmias (9.8%), bleeding (2.5%),
prolonged ventilation (4.3%) and renal replacement therapy (2.5%). In ACHD patients
total in-hospital stay was longer in patients with longer cardiopulmonary bypass (CPB)
time (p = 0.005), aortic cross clamp time (p = 0.013) and higher preoperative alkaline phosphatase level (p = 0.005). Early postoperative complications were higher in ACHD patients with longer
cardiopulmonary bypass time (p = 0.04) and presence of pulmonary artery hypertension (p = 0.012).
Conclusions
Even though the preoperative and operative characteristics are similar to both groups,
the morbidity is more in ACHD group. Longer CBP time, aortic cross clamp time and
presence of pulmonary hypertension are risk factors for higher morbidity in this group.
Keywords
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References
- Report of the British Cardiac Society Working Party Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK.Heart. 2002; 88: i1-i14
- The care of adult patients with congenital heart defects: a new challenge.Ital Heart J. 2004; 5: 178-182
- Care of adults with congenital heart disease. A challenge for the new millennium.J Thorac Cardiovasc Surg. 2001; 49: 30-34
- Seventeen years of adult congenital heart surgery: a single centre experience.Eur J Cardiothorac Surg. 2009; 36: 96-104
- Changing practice of cardiac surgery in adult patients with congenital heart disease.Heart. 2005; 91: 207-212
- Cardiac surgery in adults performed at children’s hospitals: Trends and outcomes.J Thorac Cardiovasc Surg. 2008; 136: 307-311
- Adult congenital heart disease: intensive care management and outcome prediction.Intensive Care Med. 2007; 9: 652-659
- Does the Aristotle score predict outcome in congenital heart surgery.Eur J Cardiothorac Surg. 2006; 29: 986-988
- Morbidity and Mortality Risk Factors in Adults With Congenital heart Disease Undergoing Cardiac Reoperations.Ann Thorac Surg. 2009; 88: 1284-1289
- Relationship of admission thyroid function tests to outcome in critical illness.Anaesthesia. 1995; 50: 1022-1025
- Endocrine measurements in survivors and non-survivors from critical illness.Intensive Care Med. 2002; 28: 1301-1308
- European Congenital Heart Surgeons Association: Surgical outcome for congenital heart malformations in the adult age: A multicentric European study.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004; 7: 95-101
Article info
Publication history
Published online: June 28, 2017
Accepted:
May 12,
2017
Received in revised form:
May 3,
2017
Received:
September 21,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
