Achievements in Congenital Heart Defect Surgery: A Prospective, 40-Year Study of 7038 Patients | Journal Scan

Study Questions:

What have been the trends in short- and long-term outcomes, as well as the need for reoperation in infants and children undergoing surgery for congenital heart disease (CHD) over the last 40 years?

Methods:

A prospective study was performed at a single center. CHD diagnosis, date, and type of all operations were recorded, as was all-cause mortality obtained from a national population registry.

Results:

A total of 7,038 patients were enrolled from 1971 to 2011. The median age at first operation decreased from 1.6 years in 1971-1989 to 0.19 years in 2000-2011. For patients with complex CHD, cumulative survival until age 16 years for patients operated from 1971-1989 was 62.4% as compared with 86.9% for patients operated from 1990-2011. One-year survival for patients operated in 2000-2004 was 90.7% as compared with 96.5% for patients operated in 2005-2011. Reoperation prior to age 16 was required in 434 (11.6%) patients with simple defects as compared with 985 (33.8%) patients with complex defects. For patients with complex defects, 5-year cumulative freedom from reoperation was 66% for patients operated from 1990-1999 and 73% for patients operated from 2000-2011.

Conclusions:

The authors concluded that significant improvements in survival and a decrease in the need for reoperations were seen over the study period.

Perspective:

This study demonstrated progressive improvement in congenital heart surgery survival over the last 40 years. The need for reoperations will likely remain significant in the future given the increasing numbers of patients with complex single-ventricle CHD requiring staged palliations. As short- and long-term survival have improved, the importance of optimizing other long-term outcomes, including neurodevelopmental outcomes, quality of life, and functional status, will become increasingly important.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Cardiac Surgical Procedures, Heart Defects, Congenital, Prospective Studies, Reoperation, Survival, Thoracic Surgery


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