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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Adult congenital heart disease: experience with the surgical approach
Insights
Adults with congenital heart disease undergoing surgery experienced improved function and survival, but faced frequent complications. Further multicenter studies are needed for this growing patient group.
Area of Science:
- Cardiovascular Surgery
- Adult Congenital Heart Disease
- Surgical Outcomes
Background:
- Increasing prevalence of adults with congenital heart disease (ACHD) necessitates better understanding of surgical outcomes.
- Limited data exists on the long-term results of surgical interventions in this specific population.
Purpose of the Study:
- To analyze institutional experience with surgical treatment of adults with congenital heart disease.
- To identify risk factors and outcomes associated with surgical interventions in ACHD patients.
Main Methods:
- Retrospective analysis of 191 adult patients undergoing cardiac surgery for congenital heart defects.
- Data collected included demographics, risk factors, surgical procedures, intensive care unit (ICU) and hospital stay, bypass and clamping times, complications, and functional class.
Main Results:
- 191 patients (16-74 years) underwent surgery; 171 primary corrections (93 atrial septal defect repair) and 20 reoperations.
- Hospital mortality was 4.2%; risk factors included male sex, functional class III-IV, and older age.
- Improved functional class (1.66 to 1.11) and 6-year survival (96.2%) were observed, despite frequent complications (atrial flutter/fibrillation) especially in reoperated cases.
Conclusions:
- Surgical treatment of ACHD is feasible with low mortality and improved functional class.
- Frequent immediate and late complications require careful management.
- Multicenter studies are crucial to better define this patient population and guide future treatment strategies.
Objective:
To report the institution experience with the surgical treatment of adults with congenital heart disease due to the increasing number of these patients and the need for a better discussion of the subject.
Methods:
Retrospective analysis describing demographic data, risk factors and results.
Results:
191 patients between 16 and 74 years old were operated on. Primary correction was done in 171 cases, 93 (55%) for atrial septal defect repair. Among 20 (12%) reoperations, pulmonary valve replacement was done in six cases. The mean intensive care and hospital stay were 2.7 and 8.5 days respectively, significantly greater for the reoperated cases (P=0.001). The mean bypass and clamping times were 68.6 and 44.7 minutes respectively, greater for the reoperated cases (P<0.0001 and P=0.0003 respectively). Hospital mortality was 4.2% and male sex, functional class III-IV and older age at operation were predictive risk factors. Significant complications were more frequent in the reoperated cases (P<0.003), mainly atrial flutter and fibrillation. Among 183 patients discharged, 149 (82%) are being followed and atrial flutter and fibrillation are common. The mean functional class value improved significantly after operation (1.66 to 1.11; P<0.0001). The estimated survival was 96.2% in six years.
Conclusion:
Heart surgery in adults with congenital heart disease can be accomplished with low mortality and functional class improvement. Immediate and late complications are frequent. Multicenter studies are important to better characterize this patient population in the country.
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