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Updated: Mar 6, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Contemporary cardiac surgery for adults with congenital heart disease
Sylvain Beurtheret1,2, Oktay Tutarel3, Gerhard Paul Diller3,4
1Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.
Insights
Adults with congenital heart disease (ACHD) undergoing cardiac surgery have low mortality rates and improved functional status. Key predictors of mortality include advanced NYHA class and reduced TAPSE, emphasizing timely intervention.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease (ACHD)
- Cardiac Surgery
Background:
- Advances in congenital heart disease (CHD) management have increased the adult population with CHD (ACHD).
- Many ACHD patients require cardiac surgery, necessitating an understanding of surgical outcomes and predictors.
- Optimal surgical timing and risk stratification are crucial for this growing patient group.
Purpose of the Study:
- To examine the outcomes of cardiac surgery in adult patients with congenital heart disease (ACHD).
- To identify predictors of early and long-term mortality following ACHD cardiac surgery.
- To evaluate functional status changes after surgery in ACHD patients.
Main Methods:
- An observational cohort study of 1090 consecutive ACHD patients undergoing 1130 cardiac operations between 2002 and 2011.
- Primary outcome: early mortality. Secondary outcomes: midterm/long-term survival, reoperation, interventions, and new-onset arrhythmia.
- Statistical analysis to identify predictors of early and total mortality.
Main Results:
- Early mortality was 1.77%. Independent predictors of early mortality included NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm, and female gender.
- Over a mean follow-up of 2.8 years, 46 patients died. Predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm, and non-elective surgery.
- Ten-year survival probability was 94%. Survivors showed significant improvement in NYHA class compared to baseline.
Conclusions:
- Contemporary cardiac surgery for ACHD at a tertiary center is associated with low mortality and improved functional status.
- Multidisciplinary care is vital for successful ACHD surgical outcomes.
- Surgery should not be delayed due to concerns about reoperation.
Objective:
Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery.
Methods:
This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011. Early mortality was the primary outcome measure. Midterm to longer-term survival, cumulative incidence of reoperation, other interventions and/or new-onset arrhythmia were secondary outcome measures. Predictors of early/total mortality were identified.
Results:
Age at surgery was 35±15 years, 53% male, 52.3% were in New York Heart Association (NYHA) class I, 37.2% in class II and 10.4% in class III/IV. Early mortality was 1.77% with independent predictors NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm and female gender. Over a mean follow-up of 2.8±2.6 years, 46 patients died. Baseline predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm and non-elective surgery. The number of sternotomies was not independently associated with neither early nor total mortality. At 10 years, probability of survival was 94%. NYHA class among survivors was significantly improved, compared with baseline.
Conclusions:
Contemporary cardiac surgery for ACHD performed at a single, tertiary reference centre with a multidisciplinary approach is associated with low mortality and improved functional status. Also, our findings emphasise the point that surgery should not be delayed because of reluctance to reoperate only.
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