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Causes of late deaths after pediatric cardiac surgery: a population-based study
Heta P Nieminen1, Eero V Jokinen, Heikki I Sairanen
1Department of Surgery, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. heta.nieminen@elisanet.fi
Insights
Late deaths after pediatric cardiac surgery are often due to congenital heart defects (CHDs). Non-CHD related mortality is also elevated, highlighting the need for comprehensive care for these patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery Outcomes
- Congenital Heart Defects
Background:
- Late mortality after pediatric cardiac surgery for congenital heart defects (CHDs) remains understudied.
- Understanding causes of death is crucial for improving long-term patient outcomes and morbidity.
Purpose of the Study:
- To investigate the causes and modes of late death in patients following pediatric cardiac surgery.
- To analyze survival rates and compare them to the general population.
Main Methods:
- A retrospective study of late deaths in patients operated on for CHD in Finland (1953-1989).
- Survival analysis and cause of death identification using death certificates and postmortem examinations.
- Comparison of CHD and non-CHD related mortality with the general population.
Main Results:
- 9% of 6,024 patients died during a 45-year follow-up.
- Congenital heart defects (CHDs) were the primary cause of death in 67% of cases.
- Non-CHD related mortality was twice as high as expected, with increased deaths from neurological and respiratory diseases.
Conclusions:
- Survival rates for pediatric cardiac surgery patients are lower than the general population.
- While CHDs are the main cause of late death, elevated non-CHD related mortality requires attention.
- Heart failure was the most common mode of CHD-related death.
Objectives:
We examined the causes and modes of late death after pediatric cardiac surgery.
Background:
The late mortality of patients operated on for congenital heart defect (CHD) is comprehensively unexamined. In this study, the causes of death were examined to obtain further knowledge of the morbidity of the patients.
Methods:
We studied all late deaths of patients operated on for CHD in Finland during the years 1953 to 1989. We calculated the survival of patients, identified the causes of deaths from death certificates, and examined the modes of CHD-related deaths. We compared the survival and the causes of non-CHD-related deaths to those of the general population.
Results:
Of the 6,024 patients who survived their first operation, 592 (9%) died during the 45-year follow-up period. The progress of treatment was seen in the survival of the patients operated on in different decades. The cause of death was confirmed with postmortem examination in 474 (81%) cases. The majority of patients (397, 67%) died owing to the CHD. Furthermore, non-CHD-related mortality was twice as high (risk ratio 1.9, 95% confidence interval 1.5 to 2.4) as expected. The main mode for CHD-related death was heart failure (40%). Other modes included perioperative (26%), sudden (22%), and cardiovascular (12%) deaths. The number of deaths caused by neurological and respiratory diseases was higher and the number of accidental deaths was lower than expected.
Conclusions:
The survival of patients was lower than that of the general population (relative 45-year survival 89%). Most patients died owing to CHDs, but non-CHD-related mortality was also high.
