Advanced

Midterm Results of Surgery for Adults with Congenital Heart Disease Centralized to a Swedish Cardiothoracic Center.

Nozohoor, Shahab LU ; Gustafsson, Ronny LU ; Kallonen, Janica and Sjögren, Johan LU (2013) In Congenital Heart Disease 8(4). p.273-280
Abstract
OBJECTIVE: The surgical management of adults with congenital heart disease (ACHD) offers a great challenge, with a large number of anomalies with complex pathophysiology necessitating specific treatments. Pre- and postoperative morbidity has been relatively high, and the influencing factors are not completely identified. We sought to evaluate the incidence and predictors of postoperative complications following surgery for ACHD centralized to a Swedish cardiothoracic center. DESIGN: Between April 2003 and May 2012, 191 consecutive patients with ACHD underwent 192 surgical procedures at our department. Pre-, intra-, and postoperative data were prospectively entered in a clinical database and retrospectively reviewed. Multivariate analysis... (More)
OBJECTIVE: The surgical management of adults with congenital heart disease (ACHD) offers a great challenge, with a large number of anomalies with complex pathophysiology necessitating specific treatments. Pre- and postoperative morbidity has been relatively high, and the influencing factors are not completely identified. We sought to evaluate the incidence and predictors of postoperative complications following surgery for ACHD centralized to a Swedish cardiothoracic center. DESIGN: Between April 2003 and May 2012, 191 consecutive patients with ACHD underwent 192 surgical procedures at our department. Pre-, intra-, and postoperative data were prospectively entered in a clinical database and retrospectively reviewed. Multivariate analysis was used to identify determinants of postoperative complications as a composite end point. RESULTS: The 30-day mortality was 0.5%. Overall survival was 98.3% ± 1.0 at 1 year and 98.3% ± 1.0 at 5 years postoperatively. Repeat sternotomy had to be performed in 94 patients (49%). New onset atrial fibrillation or flutter was the most prevalent (13%, n = 17/135) postoperative complication. Independent risk factors for major postoperative complications were age (odds ratio [OR] 1.81/10 year increment, P = 0.001; 95% confidence interval [CI] 1.29-2.53), reduced (<50%) systemic left ventricle ejection fraction (OR 3.61, P = 0.031; 95% CI 1.13-11.6), and the duration of cardiopulmonary bypass (OR 3.34/60 minute increase, P < 0.001; 95% CI 2.03-5.49). CONCLUSIONS: Our present data suggest that surgery in ACHD can be performed in centralized units with an excellent early and midterm survival. The incidence of postoperative complications was relatively low consisting mainly of supraventricular arrhythmias. In our opinion, ACHD surgery should be performed in centralized units with experienced surgeons in a dedicated multidisciplinary team for optimized postoperative management. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Congenital Heart Disease
volume
8
issue
4
pages
273 - 280
publisher
Wiley-Blackwell
external identifiers
  • wos:000326501000009
  • pmid:22967060
  • scopus:84880696268
ISSN
1747-079X
DOI
10.1111/chd.12000
language
English
LU publication?
yes
id
0bbb7aa8-dd5b-48c8-9ebe-36d5536e52df (old id 3124039)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22967060?dopt=Abstract
date added to LUP
2012-10-04 17:32:33
date last changed
2019-02-20 01:27:18
@article{0bbb7aa8-dd5b-48c8-9ebe-36d5536e52df,
  abstract     = {OBJECTIVE: The surgical management of adults with congenital heart disease (ACHD) offers a great challenge, with a large number of anomalies with complex pathophysiology necessitating specific treatments. Pre- and postoperative morbidity has been relatively high, and the influencing factors are not completely identified. We sought to evaluate the incidence and predictors of postoperative complications following surgery for ACHD centralized to a Swedish cardiothoracic center. DESIGN: Between April 2003 and May 2012, 191 consecutive patients with ACHD underwent 192 surgical procedures at our department. Pre-, intra-, and postoperative data were prospectively entered in a clinical database and retrospectively reviewed. Multivariate analysis was used to identify determinants of postoperative complications as a composite end point. RESULTS: The 30-day mortality was 0.5%. Overall survival was 98.3% ± 1.0 at 1 year and 98.3% ± 1.0 at 5 years postoperatively. Repeat sternotomy had to be performed in 94 patients (49%). New onset atrial fibrillation or flutter was the most prevalent (13%, n = 17/135) postoperative complication. Independent risk factors for major postoperative complications were age (odds ratio [OR] 1.81/10 year increment, P = 0.001; 95% confidence interval [CI] 1.29-2.53), reduced (&lt;50%) systemic left ventricle ejection fraction (OR 3.61, P = 0.031; 95% CI 1.13-11.6), and the duration of cardiopulmonary bypass (OR 3.34/60 minute increase, P &lt; 0.001; 95% CI 2.03-5.49). CONCLUSIONS: Our present data suggest that surgery in ACHD can be performed in centralized units with an excellent early and midterm survival. The incidence of postoperative complications was relatively low consisting mainly of supraventricular arrhythmias. In our opinion, ACHD surgery should be performed in centralized units with experienced surgeons in a dedicated multidisciplinary team for optimized postoperative management.},
  author       = {Nozohoor, Shahab and Gustafsson, Ronny and Kallonen, Janica and Sjögren, Johan},
  issn         = {1747-079X},
  language     = {eng},
  number       = {4},
  pages        = {273--280},
  publisher    = {Wiley-Blackwell},
  series       = {Congenital Heart Disease},
  title        = {Midterm Results of Surgery for Adults with Congenital Heart Disease Centralized to a Swedish Cardiothoracic Center.},
  url          = {http://dx.doi.org/10.1111/chd.12000},
  volume       = {8},
  year         = {2013},
}