Congenital heart defect-related deaths among patients undergoing surgery for congenital cardiac defects have significantly decreased over the past 60 years, according to recent data from the Journal of the American College of Cardiology. 

Data regarding late post-operative causes of death among patients with congenital heart defects could improve clinical management during follow-up.  Therefore, Alireza Raissadati, MD, of the Hospital for Children and Adolescents at Helsinki University Central Hospital in Finland, and colleagues analyzed the late causes of death after congential cardiac surgery by era and defect severity in 10 964 patients.

The researchers obtained data from a nationwide pediatric cardiac surgery database and Finnish population registry. In their analysis, they included patients who underwent cardiac surgery who were younger than 15 years of age from 1953 to 2009. They classified noncyanotic as “simple” and cyanotic events as “severe,” and compared the deaths among the study population to a matched control population.

“As expected, patients with severe cardiac defects were on average younger at the time of death compared to those with simple defects,” the authors of the study wrote. “Compared to the often single-staged correction of simple defects, surgically staged palliation or correction of severe cardiac defects places greater strain on the heart, and predisposes patients to operative death after subsequent reinterventions or early cardiovascular deaths.”


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Patients underwent 14 079 operations, with 98% follow-up. Early mortality, defined as less than 30 days, occurred in 5.6% of patients (n=613) and late mortality occurred in 10.4% of patients (n=1129).

Researchers found that congenital heart defect-related deaths (6.6%) correlated with defect severity. Furthermore, heart failure was the most common mode of congenital heart defect-related death, but the 40-year freedom from fatal heart failure was 98% after surgery for simple defects and 89% after surgery for severe defects (hazard ratio: 1.6; 95% confidence interval: 1.5-1.7; P<.0001). There was also an increase in 20-year survival for severe defects operated on from 1953 to 1989 and 1990 to 2009 (92% to 96%, respectively).

Rate of sudden death after surgery for atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition of the great arteries decreased to 0 following operations from 1990 to 2009. Mortality from neoplasms, respiratory, neurological, and infectious disease were more common in the study population than the healthy controls. Pneumonia was the most common cause of non-congenital heart defect-related death among study patients.

“Patients undergoing surgery for severe cardiac defects remain at risk for late heart failure, warranting intensive follow-up decades after surgery,” the authors concluded. Respiratory disease, particularly pneumonia, remains a significant cause of non–congenital heart disease-related death among patients, and should be identified and treated in a timely manner.”

Reference

Raissadati A, Nieminen H, Haukka J, et al. Late causes of death after pediatric cardiac surgery: a 60-year population-based study. J Am Coll Cardiol. 2016;68(5):487-498. doi: 10.1016/j.jacc.2016.05.038.