Cor Vasa 2016, 58(3):e317-e327 | DOI: 10.1016/j.crvasa.2015.12.005

Operations of adults with congenital heart disease - Single center experience with 10-year results

Jana Rubáčková Popelová^a,*, Roman Gebauer^a, Štěpán Černý^a, Petr Pavel^a, Ferdinand Timko^a, Pavel Jehlička^a, Petr Plášil^a, Jakub Tomek^b, Markéta Tomková^a,c, Ivo Skalský^a

^a Kardiochirurgické oddělení, Nemocnice Na Homolce, Praha, Česká republika

^b Department of Anatomy, Physiology and Genetics, University of Oxford, Oxford, Velká Británie

^c Nuffield Department of Medicine, University of Oxford, Oxford, Velká Británie

During the last 10 years, 844 operations of 805 adults with congenital heart disease (CHD) were performed in Hospital Na Homolce in Prague, Czech Republic. The median age was 37 (interquartile range 25-49, full range 16-81) years. Operations of complex and rare CHD represented 47%. Fourty-four percent of patients (354) underwent previous cardiac surgery in childhood or adulthood. Three and more operations were performed in 14% (113 patients). Combined surgical procedures were performed in 70% of operations.
Thirty-day mortality was 1.36%, hospital mortality 1.7% and 5-year survival probability 97%. The risk factors for early and late mortality were NYHA class III and IV symptoms (p < 0.0001; OR 30.8), history of heart failure (p = 0.001; OR 6.7), cyanosis (p < 0.0001; OR 60.5), number of previous operations (p = 0.00033), presence of mechanical prosthetic valves (p = 0.0032; OR 3.7) and univentricular circulation (p = 0.0276; OR 5.4). The difference was not significant for arrhythmias (p = 0.078), pulmonary hypertension (p = 0.072), age at operation (p = 0.372) and gender (p = 0.48).
Centralization of adult CHD care in a high volume center carries very good surgical results with low early and late mortality. It is important to perform the operations in time and to eliminate all residual lesions by combined surgical procedure. The presence of pediatric cardiac surgeon is necessary for the operations of complex CHD.

Keywords: Congenital heart disease in adults; Heart reoperations; Operations; Risk factors; Surgical mortality

Received: November 18, 2015; Revised: December 24, 2015; Accepted: December 29, 2015; Published: June 1, 2016  Show citation