Late Results of Pediatric Cardiac Surgery in Finland

Abstract

A Population-Based Study With 96% Follow-UpHeta P. Nieminen, MD; Eero V. Jokinen, MD; Heikki I. Sairanen, MDBackground-This population-based study characterizes the history and progress of pediatric cardiac surgery in Finland.For the first time, all defects and procedures are included in an outcome study, reflecting the true effectiveness of operative treatment. Methods and Results-All data relating to the operations were collected retrospectively from hospital records. Current patient status was obtained from the population registry. Survival was evaluated with the Kaplan-Meier method applied to all patients and separately to subgroups of patients with the most common defects. The survival rates were compared with those of an age-and sex-matched general population. During the 37 years (1953 to 1989), 6461 patients underwent surgery; 96% of them were traced. The number of operations and the constellation of defects treated increased dramatically over time. Actuarial survival for the 45 years ended October 28, 1998 (the ending date of this study) was 78% for patients versus 93% for the general population. Survival and the number of operations per patient varied widely with the defect. The survival of patients with a surgically closed atrial septal defect was comparable to that of the general population, and such patients rarely needed a reoperation, whereas only 15% of patients with univentricular heart survived for 34 years, and almost all needed at least 2 operations. Conclusions-The overall survival of patients with cardiac defects corrected surgically in childhood is good compared with their estimated natural course. The increasing number of surgically treatable defects and the growing number of operations per patient reflect the increasing ability to treat more difficult cases. (Circulation. 2001;104:570-575.)

Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis

“…A Finnish cohort study identified a historical cohort of children operated for congenital heart defects between 1953 and 1989 and achieved 96% follow-up of these cases through linked data sources. 77 The follow-up time for individual cases ranged from 9 to 45 years, with a mean follow-up of 22 years, and was calculated from the time of first operation. The cases followed up therefore received surgery at different ages and at different periods so will have experienced both older and newer surgical techniques.…”

“…HLH syndrome. 22,78,79 In the Finnish study, 16% of affected children had undergone more than one heart operation, 77 varying from 16% of those with COA to 33% of children with TGA, VSDs or TOF and 80% of univentricular hearts (UVHs).…”

“…77 In the systematic review undertaken for the Bristol Inquiry, 63 early surgical mortality was compared for the higher risk open-heart procedures in the period 1984-95: improvement over time was observed for each operation. The early surgical mortality estimates for these studies are summarised in Table 4.…”

“…77 However, this study summarised deaths over a long period during which surgical techniques changed considerably. The most common causes of death in adults with congenital heart defects are sudden cardiac death (arrhythmia), progressive heart failure and perioperative death.…”

314 Healthcare-Associated Infections in Pediatrics

“…Procedure-associated data from the Finnish Research Registry of Pediatric Cardiac Surgery [243] were utilized. Procedures were grouped according to the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method, previously used to assess institutional performance by comparing observed and expected short-term mortality rates within risk categories [244].…”