Outcome of Complex Adult Congenital Heart Surgery in the Developing World

Abstract

A retrospective evaluation of 153 adults with congenital heart disease who underwent open heart surgery at a single center in India showed strikingly fewer reoperations compared with large European studies. There was a similar prevalence of complex lesions. Surgical mortality was low, and long-term functional outcome was gratifying.

Twenty Years of Adult Congenital Heart Surgery

“…This is reassuring when considered in the context of mortality rates reported by large European series 9,10,17,18 and in light of the fact that we are a low-volume unit with an average of one ACHD case being performed a month (11.5 cases/year). When compared to reported developing world figures, 11,12,13 our mortality rates were lower, despite the higher incidence of complex pathologies and reoperations in our series. Our reoperative mortality rate is 3.1% (4.5% if the palliative procedure mortality, which was a resternotomy procedure, is included).…”

“…Preoperative cardiac angiography and catheterization was utilized as diagnostic modality in 85% of our patients. This contrasts markedly to the European series 9 (catheterization rate of 19.8%) and the 2 Asian series quoted 11,12 (catheterization rates of 10.4% and 12.4%, respectively). Possible reasons for our catheterization rate are our past strict adherence to the age recommendation for preoperative coronary angiography, the fact that a new generation multislice computed tomography scanner had only recently been acquired and that resources to implement a cardiac magnetic resonance imaging program at our institution had been lacking until recently.…”

“…The incidence of single-ventricle patients in our study was low, probably due to the fact that patients with hypoplastic left heart syndrome are offered comfort care only at our institution. The clinical profile of ACHD reported in single-center studies from India 11 and Indonesia 12 revealed a very high proportion of atrial septal defects (ASDs), with septal defects constituting in the region of 80% of diagnoses in both studies. In a surgical ACHD study from Ghana, 13 VSD, ASD, tetralogy of Fallot, and patent ductus arteriosus accounted for 78% of diagnoses, while in our study these four diagnoses accounted for 38% of cases.…”

Programmatic Changes to Reduce Mortality and Morbidity in Humanitarian Congenital Cardiac Surgery

“…We believe that although a mortality of 5.13% is significantly higher than that reported by the STS, it is not significantly higher than the rate reported by other developing nations. 15,16 It should be noted that, unlike patients undergoing repair of ASDs or VSDs, these patients tend to be significantly more cyanotic with very high hemoglobin levels, and this may predispose the patients toward both preexisting coagulopathies and neurologic injuries. Ongoing research is needed to better delineate what factors are driving the observed rate and what policies may aid in reducing it.…”

Prolonged length of stay after surgery for adult congenital heart disease: a single-centre study in a developing country

“…4 This older age at operation may be associated with longer ICU and hospital stay. 5,6 Prolonged length of stay has been identified as a significant adverse outcome after adult CHD surgery. There are several factorspre-, intra-, and post-operativethat contribute to prolonged length of stay after CHD surgery.…”