Related Experiment Videos
Cardiac surgery for grown-up congenital heart patients: survey of 307 consecutive operations from 1991 to 1994
1Grown-Up Congenital Heart Unit, Royal Brompton Hospital and National Heart and Lung Institute, London, England.
Insights
Reoperations are more common than initial surgeries in grown-up congenital heart patients. Cyanosis, prior operations, and age significantly impact early mortality and complications in this population.
Area of Science:
- Cardiovascular Surgery
- Adult Congenital Heart Disease
Background:
- The care of grown-up congenital heart (GUCH) patients presents unique challenges due to the increasing survival of individuals with complex cardiovascular malformations.
- A dedicated unit for GUCH patients allows for specialized review of surgical interventions.
Purpose of the Study:
- To analyze the frequency and types of cardiac surgeries performed in GUCH patients.
- To determine the incidence of initial operations versus reoperations and identify factors influencing early mortality.
Main Methods:
- Retrospective review of 307 cardiac operations performed between 1991 and 1994 in a specialized GUCH unit.
- Analysis of patient demographics, surgical procedures, reoperation rates, and early mortality determinants.
Main Results:
- Reoperations (58%) were more frequent than first operations (42%) in 295 GUCH patients.
- Early mortality was significantly higher in cyanotic patients (18%) compared to acyanotic patients (5%), and influenced by the number of previous operations and patient age.
- Cyanotic patients experienced more severe postoperative complications and longer hospital stays.
Conclusions:
- Reoperations constitute the majority of cardiac surgical procedures in GUCH patients, highlighting the long-term management needs.
- Specialized, concentrated care in designated centers is essential for managing the complex challenges faced by GUCH patients and their surgeons.
- Continued highly specialized care and resource allocation are critical for improving outcomes in this growing patient population.
Abstract:
The cardiac surgery performed from 1991 to 1994 in a unit dedicated specifically for grown-up congenital heart (GUCH) patients was reviewed to determine the frequency of various procedures, incidence of first and reoperations, early mortality, and its determinants. The 295 patients, aged 16 to 77 years (31 +/- 13), had 307 operations. First operations (n = 128, 42%) were most commonly for closure of atrial septal defect (n = 40), aortic valve replacement (n = 31) or repair of aortic coarctation (n = 14). Reoperations were more frequent (n = 179, 58%) and divided among first corrective repair (n = 49), reoperation after corrective repair (n = 115), and further palliation (n = 15). First corrective surgery was mainly for aortic valve disease (n = 17), Fallot (n = 7), and lesions needing a Fontan procedure (n = 5). Reoperations after corrective repair were needed for aortic valve disease (n = 43), right-sided conduit (n = 30), or recoarctation (n = 11). Early mortality was influenced by presence of central cyanosis (9 of 49, 18% in cyanotic patients; 12 of 258, 5% in acyanotic; p <0.001), increased number of previous operations (0 = 4%, 1 = 7%, 2 = 11%, >2 = 13%; p = 0.003), and increasing age of patients. Cyanotic patients had more serious postoperative complications: pleural and pericardial effusions, severe bleeding, renal insufficiency, and sepsis, and their hospital stay was longer compared with acyanotic patients (20 +/- 17 vs 11 +/- 8 days; p <0.001). In GUCH patients, reoperations cause the largest demand on cardiac surgical services. Increased survival of patients with complex cardiovascular malformations brings difficult challenges not only to cardiologists but also to cardiovascular surgeons. There is a need to provide continued highly specialized care. Resources, patients, and funding should be concentrated in a few designated centers.