Outcome of cardiac surgery in adults with congenital heart disease: A single center experience

Abstract

ObjectivesAdult survivors with congenital heart diseases represent a large and growing population, yet the published data does not represent the magnitude of their needs specifically in the Middle East. We aimed to review our experience at King Faisal Heart Center, Riyadh, Saudi Arabia for the outcome of adult patients with congenital heart disease who underwent either primary or redo surgery.MethodsA retrospective study at a tertiary care hospital. All patients who underwent surgery either as the first surgery or as a reoperation for congenital heart disease aged >16 years old at the time of cardiac surgery in the period between January 1, 2008 and January 1, 2013. We looked for incidence of postoperative bleeding, arrhythmias, acute kidney injury, neurological complications, duration of mechanical ventilation, hospital and intensive care unit (ICU) stay. Additionally, we assessed the mortality and 1- and 5-year survival.ResultsNinety-eight patients were included in our study. Fifty-two (53%) were females and 46 (47%) were males, with a mean age of 26 ± 8.4 years and a mean weight of 62 ± 22.8 kg. Forty-nine patients (50%) required redo surgery. Ten patients (10%) suffered from postoperative bleeding. Eight patients (8%) had postoperative arrhythmias, of which two patients required permanent pacemaker insertion. Three patients (3%) had postoperative acute kidney injury and seven patients (7%) suffered from neurological complications. The mean duration of ventilation was 1.3 ± 2 days, with a mean ICU and hospital stay of 3.7 ± 3 days, and 10 ± 7 days, respectively. The overall mortality rate in our series was 4% with a 1–5-year survival of 96%.ConclusionAdult patients with congenital heart disease are prone to immediate postoperative multisystem complications, yet the majority of them are reversible. Their 1- and 5-year survival rate is excellent. Further follow up studies are required.

Impact of a quality improvement initiative with a dedicated anesthesia team on outcomes after surgery for adult congenital heart disease

“…Our results compare favorably with the published literature where mortality ranges from 0.7% to 9.4%. 2 , 3 , 4 , 5 Our contemporary cohort also compares well to reported morbidity rates with a recent similar single-center study reporting rates of AKI of 2.1%, stroke of 1.4%, and prolonged ventilation of 11.4%. 2 Our rate of prolonged ventilation greater than 7 days was 3.9% in the “after” group.…”

“… 2 Mortality after cardiac surgery in patients with adult congenital heart disease (ACHD) ranges from 0.7% to 9.4%. 2 , 3 , 4 , 5 , 6 …”

Evaluation of mortality scores in patients with adult congenital heart defects

“…The incidence of mortality was 13.455 times higher in patients with a cut-off value of ≥0.7 in their ACHS mortality scores. Abouelella et al [17] reported a postoperative complication rate of 18%, similar to the rate of 28% stated by Mascio et al [18] The reported incidence of neurological complications is 7%. [19] In our study, postoperative complications were detected in 13.7% of the cases (n=28), and it is consistent with the literature (Table 4).…”

“…In this study, they divided the patients into 152 groups and determined an ACHS mortality score ranging from 0.1 to 3.0 for each. In 2019, Abouelella et al [17] stated that the ACHS score is currently the best predictor of mortality in GUCH patients and that the mortality rate was 4%.…”

Severe postoperative hyperbilirubinemia in congenital heart disease

“…The analysis of our present cohort of CHD patients with severe postoperative hyperbilirubinemia showed an overall incidence of postoperative AKI of 59.3% and an in-hospital mortality rate of 10.5%. The reported AKI incidences in CHD patients who underwent CPB cardiac surgery in previous studies ranged from 11 to 51% [ 9 , 10 , 11 , 12 , 13 ], and the in-hospital mortalities ranged from 1.1 to 4% [ 10 , 14 ]. The discrepancies were most likely attributed to the differences in disease severity of the included patients between the studies.…”