Late Causes of Death After Pediatric Cardiac Surgery

Study Questions:

What are the late causes of death after congenital cardiac surgery?

Methods:

Data from a nationwide pediatric cardiac surgery database and population registry were used for this study. Patients undergoing surgery at <15 years of age between 1953 and 2009 were included. Acyanotic lesions were classified as simple and cyanotic lesions were classified as complex.

Results:

Overall, 10,964 patients underwent 14,079 operations, with 5.6% early (<30-day) mortality, and 10.4% late mortality. Heart failure was the most common congenital heart disease (CHD)–related mode of death, but decreased after surgeries performed between 1990 and 2009. No cases of sudden death after surgery were seen for patients with atrial septal defect (ASD), ventricular septal defect (VSD), and transposition of the great arteries following operations performed between 1990 and 2009. Deaths from neoplasms, respiratory, neurological, and infectious disease were significantly more common among study patients as compared with controls. The majority of non-CHD–related deaths in the study population were caused by pneumonia.

Conclusions:

CHD-related deaths have decreased markedly in the more recent surgical era, but remain a significant issue, particularly for patients with complex disease.

Perspective:

This study made use of a comprehensive national database in Finland to study long-term outcomes of patients with CHD after surgical intervention. It is encouraging that no cases of sudden death were seen in patients who had undergone repair of ASD, VSD, tetralogy of Fallot, and transposition of the great arteries between 1990 and 2009. This population however, remains young, and this will need to be watched going forward. The fact that pneumonia caused the majority of non-CHD–related deaths supports the practice of regular influenza and pneumonia vaccination for this patient population. Additionally, aortic dissection was an important cause of death for patients with coarctation of the aorta, supporting the practice of close follow-up of aortic dimensions in this patient group. Finally, the increased risk of neoplasms, particularly those potentially related to radiation exposure deserves further study, and emphasizes the need to be cognizant of the lifelong radiation exposure of patients with CHD.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD & Pediatrics and Interventions, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Aortic Coarctation, Cardiac Surgical Procedures, Death, Sudden, Heart Defects, Congenital, Heart Failure, Heart Septal Defects, Atrial, Heart Septal Defects, Ventricular, Influenza, Human, Neoplasms, Pediatrics, Pneumonia, Tetralogy of Fallot, Transposition of Great Vessels


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