I.G. LebidSingle-center study of cardiac surgery practice in adults with congenital heart disease: 15 years retrospective review

Success of pediatric cardiology and pediatric cardiac surgery has improved survival of children with congenital heart disease (CHD). This dynamics could increase their survival and life expectancy during adult period.
The aim – to estimate cardiac surgery care activity in adults with CHD through register of all surgical patients older than 16 years with CHD in Ukrainian Children’s Cardiac Centre (UCCC), to create strategy for cardiology care during late postoperative period.
Material and methods. This retrospective review included an analysis of medical case reports of all patients aged 16 years and older during period from 01 Jan 1999 to 31 Dec 2013. The date was analyzed after divided the group in to 3 periods. Period 1 – from 1999 to 2005, Period 2 – from 2006 to 2010, Period 3 – from 2011 to 2013. The anatomical diagnosis of CHD were classified into simple, moderate and severe, according to modified Canadian consensus conference criteria as used by Bethesda conference report. Presurgery status of all patients was assessed by NYHA heart failure classes.
Results. 501 surgical procedures were performed in 451 patients over the study period. There were 5 deaths (surgical mortality at 30 days was 1.1 %). Age at surgery was from 16 to 70 years, average 23.42±0.60 years. During period 1 there were 110 procedures, period 2 – 163 procedures, period 3 – 228 procedures. Surgical mortality at 30 days was 1.92 % in period 1; 1.33 % in period 2; 0.51 % in period 3. There was prevalence of cardiac surgery (99 %) in period 1. In period 2 cardiac surgery was performed in 139 patients (85 %) angio procedures – in 21 (13 %), arrhythmia procedures – in 3 (2 %). In period 3 surgery was performed in 164 patients (72 %) angio procedures – in 46 (20 %), arrhythmia procedures – in 18 (8 %). In period 1 there were 48 adults with simple CHD (46 %), 34 – with moderate CHD (32 %) and 22 with severe CHD (21 %), in period 2 – 60 adults with simple CHD (39 %), 40 – with moderate CHD (26 %) and 53 with severe CHD (35 %), in period 3 – 72 adults with simple CHD (37 %), 48 – with moderate CHD (24 %) and 74 with severe CHD (39 %). Cardiac surgery in septal defects was performed in period 1 in 45 %, in period 2 – 43 %, in period 3 – 34 %; LVOT procedures – in 27; 32 and 32 %, RVOT – in 2; 4 and 9 %, correspondingly.
Conclusions. Improving surgical care in adult CHD increases the number of patients undergoing surgery, number of procedures, along with decreasing mortality (from 1.92 to 0.51 %). More than one third of all surgical patients had complex severe heart defects requiring special training and knowledge of medical specialists for ACHD. The percentage of simple CHD in a structure of all defects was decreased, along with increased number of procedures and operations in LVOT and RVOT. Most of these procedures are reoperations

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