Mid Term Results Of Surgery Of Congenital Heart Disease In Adult Age: Italian Multicentric Study
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Objective: Despite congenital heart malformations are currently treated in infancy and childhood, a great number of patients still needs surgical treatment in adult age. We have embarked on a multicentric study involving 7 major italian centers, so as to evaluate the impact of cardiac surgery in adults with congenital heart disease in our country.
Methods: We collected data of 856 patients who underwent surgery from January,1st 2000 to December 31st 2004. Patients were divided into three groups: Group I- Palliation (3.1%): any operation performed to improve patient's clinical status without restoring normal anatomy or physiology. Bidirectional cavopulmonary anastomosis and pulmonary artery banding were the most frequent procedures. Group II- Repair (69.7%): first operation performed in the patient, to achieve an anatomic or physiologic repair by separation of the pulmonary from systemic circulation (including also Fontan-types, and 1 and ½ ventricle repairs). Most frequent procedures were: atrial septal defect closure (35.8%), partial anomalous pulmonary venous connection repair (7.2%), ventricular septal defect closure (5.3%). Group III- Reoperation (27.4%): all procedures performed after repair either anatomic or physiologic. The most frequent procedures were conduit replacement (9.8%), aortic (8.6%) or pulmonary valve replacement (7.7%) .
Results: Preoperatively 34.6% of patients were in NYHA class I, 48.4% in class II, 14.2% in class III and 2.8% in class IV. Synus rhythm was present in 83%.There were 1179 procedure performed in 856 patients (1.37 procedure/patient), with a hospital mortality of 3.1%. Overall mean intensive care unit stay was 2.3 days (range:1-102 days). Major complications were reported in 247 pts (28.8%), with postoperative arrhythmias being the most frequent (26%). At mean follow-up of 22 months (range 1 month-5.5 years), 86% of data were available. Late death occurred in 5 patients (0.5%). Patients were in NYHA class I in 79.3 %, II in 17.6%, III in 2.9%, and only one patient in class IV (0.11%). Ability index was class I in 82%, class II in 13.7% and class III in 2.3%.Overall survival estimates is 89% , 95% and 89% at 5 years for groups I, II, III respectively. Freedom from adverse events at 5 years is 97.8% for acyanotic vs 88.2 % for preoperative cyanotic patients (p < 0.05).
Conclusions: Surgery for congenital heart disease in adult age is a safe and a low risk treatment. However patients with preoperative cyanosis show a higher incidence of late non-fatal complications.
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