Death rates after surgery due to congenital heart defects have fallen

According to recent data from Journal of the American College of Cardiology.

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

The researchers obtained data from a national pediatric cardiac surgery database and the Finnish population register. In their analysis, they included heart surgery patients who were younger than 15 years old from 1953 to 2009. They categorized non-cyanotic events as “simple” and cyanotic events as “severe,” and compared deaths among the study population to a matched number. control the population.


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“As expected, patients with severe heart defects were on average younger at the time of death compared to those with simple flaws,” the study authors wrote. “Compared to the correction often in a single step of simple defects, surgically staged palliation or correction of severe heart defects put more pressure on the heart, and predisposes patients to operative death after reoperations or early cardiovascular death.

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).

The researchers found that deaths related to congenital heart defects (6.6%) were correlated with the severity of the defects. Additionally, heart failure was the most common mode of congenital heart defect-related death, but freedom from fatal heart failure over 40 years was 98% after surgery for simple defects and 89% after surgery. surgery for severe malformations (relative risk: 1.6; 95% confidence interval: 1.5-1.7; P<.0001 there was also an increase in survival for severe malformations operated on from to and respectively>

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

“Patients undergoing surgery for serious heart disease malformations remain at risk of late heart failure, warranting intensive follow-up decades after surgery,” the authors concluded. Respiratory diseases, particularly pneumonia, remain a leading cause of death from non-congenital heart disease in patients, and must be identified and treated in a in right time.

Reference

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