Outcomes in adult congenital heart surgery: Analysis of the Society of Thoracic Surgeons Database

Abstract

Objective(s) Outcomes data for adults undergoing congenital heart surgery are limited. Previous analyses utilized administrative data or focused on single-center outcomes. We describe the most common operations, patient characteristics, and post-operative outcomes using a multicenter clinical database. Methods Adults (≥ 18 years) in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database ((2000–2009) were included. Patient characteristics and morbidity and mortality were described. We similarly examined congenital procedures in the STS Adult Cardiac Surgery Database to permit consideration of the primary dataset within a broader context. Results 5265 patients (68 centers) from the STS Congenital Heart Surgery Database were included. Median age was 25 years (IQR 20–35). Common preoperative risk factors included noncardiac abnormalities (17%) and arrhythmia (14%). Overall, in-hospital mortality was 2.1%, 27% had ≥1 complication and median length of stay was 5 days. Common operations included right ventricular outflow tract procedures (21%) and pacemaker/arrhythmia procedures (20%). We further evaluated cardiopulmonary bypass procedures with n >100. Mortality ranged from 0% (atrial septal defect repair) to 11% (Fontan revision/conversion). Separate evaluation of the STS Adult Cardiac Surgery Database revealed 39,872 adults undergoing congenital heart operations. Conclusion Most adult congenital heart operations in the STS Congenital Heart Surgery Database are performed in the third-fourth decades of life; nearly half are for right heart pathology or arrhythmia. Many patients have complications but mortality is low with the exception of those undergoing Fontan revision/conversion. Many more adults undergoing congenital heart surgery are entered into the STS Adult Cardiac Surgery Database.

Congenital Heart Disease in the Older Adult

“…[346][347][348][349] Recently, there have been an increasing number of reports regarding results after surgical closure among elderly patients (>60 years of age) that demonstrate equivalent survival to younger patients, albeit with slightly higher complication rates. 36,350,351 In a study 36 of 68 patients between 68 and 86 years of age at a single institution undergoing either surgical (n=13) or device (n=54) closure, the incidence of major complications (including pneumothorax, heart failure, and pneumonia) was 23%, higher than that recently reported 352 using the Society of Thoracic Surgeons' Congenital Heart Surgery Database (20%) and in another recent single-institution review 353 (12%). Of note, however, there were no operative deaths among the elderly cohort.…”

“…352 Current indications for PVR are listed in Table 3. Pulmonary valve regurgitation after repair of TOF is relatively well tolerated in the short term, in part because the hypertrophied RV usually adapts to altered hemodynamic load.…”

“…Among 5265 ACHD patients catalogued in the Society of Thoracic Surgeons' Congenital Heart Surgery Database, Fontan revisions accounted for <1% of all surgical procedures, and no patients were >33 years of age. 352 Patients with failed Fontan physiology may present with refractory cyanosis, arrhythmia, edema attributable to protein losing enteropathy, cirrhosis, outflow tract obstruction, or AV valve dysfunction. Complete discussion of all of these is beyond the scope of the present report and, as mentioned above, may be currently irrelevant to the present statement.…”

Congenital Heart Surgery: Analysis of 102 Cases

“…However, the outcomes of surgery in these adult CHD patients were very good. In an analysis of the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database ((2000-2009) 6 including 5265 patients ageing >18 years, the overall, in-hospital mortality was 2.1%, and 27% had >1 complication. On the other hand, the present series had no in-hospital mortality or major complications.…”

“…Noteworthy here, like the series presented here, mortality was 0% in ASD patients in Congenital Heart Surgery Database. 6 One of the current controversies in the field of adult CHD is whether patients should be cared for at an adult or pediatric facility and by an adult or pediatric heart surgeon. In a series 5 of 303 operations performed on adults (age >18 years) with CHD, 185 operations were performed in an adult hospital and 118 in a pediatric hospital, 46 operations were performed by an adult heart surgeon and 257 by a congenital heart surgeon.…”