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Mode of death in adults with congenital heart disease
E N Oechslin1, D A Harrison, M S Connelly
1University of Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University of Toronto, Ontario, Canada.
Insights
Adults with congenital heart disease (CHD) face sudden death, progressive heart failure, and perioperative complications as primary causes of mortality. Understanding these adult CHD death modes is crucial for improved long-term care.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Mortality Studies
Background:
- The population of adults with congenital heart disease (CHD) is growing.
- Prior research on CHD mortality primarily focused on pediatric populations.
- Modes of death in adult CHD patients remain poorly defined.
Purpose of the Study:
- To define the primary causes of death in adult patients with congenital heart disease.
- To identify specific CHD conditions associated with higher mortality.
- To analyze the timing and mechanisms of death in this population.
Main Methods:
- Cross-sectional study of 2,609 adult CHD patients assessed at a specialty clinic.
- Analysis of mortality data from 197 deceased patients with available information.
- Review of postmortem examination findings for 77 patients.
Main Results:
- The mean age at death was 37 years.
- Highest mortality rates were observed in patients with congenitally corrected transposition of the great arteries (26%), tricuspid atresia (25%), and univentricular connection (23%).
- Sudden death (26%), progressive heart failure (21%), and perioperative death (18%) were the leading causes of mortality.
Conclusions:
- Sudden death, progressive heart failure, and perioperative complications are the three major causes of mortality in adults with CHD.
- Specific complex heart conditions are associated with increased mortality risk.
- Postmortem examinations provide valuable insights into the mechanisms of death in adult CHD.
Abstract:
An increasing number of patients with congenital heart disease (CHD) are entering adulthood. Although prior studies have focused on the causes of death in the pediatric population, the modes of death for adults with CHD have not been well defined. In a cross-sectional study performed on a population of 2,609 consecutive adults assessed at a CHD specialty clinic, there were adequate information available in 197 of 199 deceased patients. Mean age at death was 37 +/- 15 years. Mortality was highest in patients with congenitally corrected transposition of the great arteries (26%), tricuspid atresia (25%), and univentricular connection (23%). Youngest mean age at death was observed in patients with tricuspid atresia (27 +/- 5 years), complete transposition of the great arteries (27 +/- 7 years), pulmonary atresia (27 +/- 6 years), and aortic coarctation (29 +/- 6 years). Sudden death (26%) was the most common cause of death followed by progressive heart failure (21%) and perioperative death (18%). Postmortem examinations were performed in 77 of 197 deceased patients (39%) and provided incremental data on the mechanism of death in 22% of autopsies. Thus, the 3 major causes of death in the growing population of adults with CHD are sudden, perioperative, and progressive heart failure.