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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Adult congenital cardiac surgery in Indonesia
Karina V Wilamarta1, Yoga Yuniadi, Jusuf Rachmat
1Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Insights
Surgical treatment for adult congenital heart disease in developing nations is effective, with a 96.3% survival rate at 60 months. Palliative surgery for non-atrial septal defects is not recommended due to high mortality. Post-operative New York Heart Association class III-IV predicts death.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Surgical Outcomes
Background:
- Increased survival in pediatric cardiac care leads to more adults with congenital heart disease requiring treatment.
- Developing countries face challenges like late detection and socioeconomic factors impacting adult congenital heart disease patient characteristics.
- This study focuses on the long-term surgical results for adult congenital heart disease in Indonesia.
Purpose of the Study:
- To evaluate the long-term surgical outcomes of adult congenital heart disease patients in a developing country context.
- To identify predictors of mortality and re-operation in this population.
- To assess the safety and efficacy of surgical interventions for adult congenital heart disease in Indonesia.
Main Methods:
- Retrospective review of adult congenital heart disease patients undergoing surgery at the National Cardiovascular Center.
- Analysis of patient demographics, surgical procedures (corrective, palliative, re-operations), and outcomes.
- Statistical analysis to determine survival rates, re-operation rates, and predictors of mortality.
Main Results:
- Overall hospital mortality was 2.6%, with palliative surgery showing a 20% mortality rate.
- The 60-month survival rate was 96.3% overall, highest with corrective procedures (97.6%).
- Post-operative New York Heart Association class III-IV was the sole independent predictor of death at 60 months.
Conclusions:
- Surgical treatment for adult congenital heart disease in developing countries is effective and safe, with high survival rates.
- Palliative surgery for non-atrial septal defects should be reconsidered due to its high mortality.
- Post-operative functional class is a critical factor influencing mortality in adult congenital heart disease patients.
Background:
Successful paediatric cardiac surgery and cardiology treatment has resulted in an increase in the use of surgery as a method of treatment of congenital cardiac disease in adult population. However, late detection and lower socio-economic condition in developing countries might change patients' characteristics by the time they come for treatment. This study aimed to elaborate the long-term surgical results of adult congenital cardiac disease in Indonesia as a developing country.
Methods And Results:
We reviewed retrospectively all adult congenital cardiac disease patients with a mean age of 28 years plus or minus 9.5 years, who underwent surgery at National Cardiovascular Center. The types of procedures used were corrective in 338 patients (89.2%), palliative in 10 patients (2.6%), and re-operations in 31 patients (8.2%). The overall hospital mortality rate was 2.6% but as high as 20% with palliative surgery. Post-operative New York Heart Association class III-IV is the only independent predictor of death at 60 months (hazard ratio 61.48, 95% confidence interval 9.41-401.69, p<0.001). The survival rates were 96.3% and 95% for overall and non-atrial septal defect in patients at 60 months, which was highest in corrective procedures (97.6%). The percentage of patients free of re-operation at 5 years' follow-up was 85.4% and 42.7% at 10 years.
Conclusion:
In developing countries, surgical treatment of adult congenital cardiac disease is effective and safe, with an overall survival rate of 96.3% at 60 months. Due to high mortality rate, palliative surgery of a non-atrial septal defect patient is recommended to be discontinued. The independent predictor of mortality was post-operative New York Heart Association functional class III-IV.
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