Twenty-seven-year Institutional Experience With Surgery For Adults With Congenital Heart Disease
Aeleia Frances Hughes, BS, Jeremy Herrmann, MD, Mark Rodefeld, MD, James Slaven, MS, Mark Turrentine, MD, John Brown, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
Objective(s): Given improved survival of adults with congenital heart disease (ACHD), we aimed to evaluate trends in ACHD surgery and outcomes at a single center over a 27-year period.
Methods: Surgical databases were retrospectively queried for patients >18 years old who underwent ACHD surgery between January 1, 1994, and December 31, 2020. Patients were grouped by era: I, 1994-2000; II, 2001-2010; III, 2011-2020. ANOVA tests were used for continuous variables and Mantel-Haenszel Chi-Square tests were used for ordinal/trend categorical data. Cox Proportional hazards models were performed to determine the association between risk factors and mortality.
Results: A total of 2045 patients (requiring 2256 operations) met inclusion criteria (Table 1). Mean age at operation increased across eras. Mean number of prior cardiac surgical procedures increased from 0.53+0.80 (Era I) to 0.57+0.97 (Era II) to 0.68+1.03 (Era III) (p=0.0347), with most patients undergoing their first cardiac surgery in adulthood. The most common procedures are listed in Table 1. Proportions of aortic valve anomalies and aortic valve replacements increased significantly over time while mortality decreased.
Delayed sternal closure (HR=9.10, p<0.01) and postoperative extracorporeal membrane oxygenation (HR=8.96, p<0.01) were associated with mortality.
Conclusions: In the largest presented single series of ACHD surgical patients, we observed increasing patient age and prior interventions across eras with improvement in overall survival. Future prospective work will help track patient complexity and outcomes.
| Overall (n=2256) | Era 1 (N=170) 1994 - 2000 | Era 2 (n=896) 2001 - 2010 | Era 3 (n=1190) 2011 - 2020 | P-value | |
| Age (years) | 45.3 (16.6) | 36.7 (14.1) | 45.0 (17.6) | 46.8 (15.8) | <0.0001 |
| Body surface area (m2) | 2.0 (0.4) | 1.5 (0.4) | 2.0 (0.5) | 2.0 (0.3) | <0.0001 |
| Aortic valve anomalies | 1332/2256 (59.0) | 90/170 (52.9) | 518/896 (57.8) | 724/1190 (60.8) | 0.0312 |
| Atrial septal defect | 407/2256 (18.0) | 25/170 (14.7) | 173/896 (19.3) | 209/1190 (17.6) | 0.9989 |
| Tetralogy of Fallot/Double outlet right ventricle | 176/2256 (7.8) | 12/170 (7.1) | 67/896 (7.5) | 97/1190 (8.2) | 0.4999 |
| Aortic procedure | 936/2256 (41.5) | 80/170 (47.1) | 360/896 (40.2) | 496/1190 (41.7) | 0.6264 |
| Aortic valve replacement | 749/2256 (33.2) | 18/170 (10.6) | 263/896 (29.4) | 468/1190 (39.3) | <0.0001 |
| Follow-up (months) | 51 (15, 144) | 265 (174, 296) | 120 (30, 165) | 37 (9, 70) | 0.006 |
| Mortality (patients) | 279 (12.4%) | 30 (17.7%) | 141 (15.7%) | 108 (9.1%) | <0.0001 |
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