PMID- 23462261
OWN - NLM
STAT- MEDLINE
DCOM- 20130514
LR  - 20130325
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 95
IP  - 4
DP  - 2013 Apr
TI  - Surgery in adults with congenital heart disease: risk factors for morbidity and 
      mortality.
PG  - 1377-82; discussion 1382
LID - S0003-4975(13)00085-4 [pii]
LID - 10.1016/j.athoracsur.2012.11.076 [doi]
AB  - BACKGROUND: Patients with congenital heart disease are frequently surviving into 
      adulthood, and many of them will require surgery. Unfortunately, outcome data in 
      this patient population are limited. We aimed to identify risk factors associated 
      with adverse events in adults with congenital heart disease undergoing cardiac 
      surgery and establish long-term survival data. METHODS: We retrospectively 
      studied 458 adult patients who underwent cardiac surgery for congenital heart 
      disease between 2000 and 2010. We constructed logistic models to assess risk 
      factors for mortality, major adverse event (stroke, renal failure, prolonged 
      ventilation, prolonged coma, deep sternal infection, reoperation, and operative 
      mortality), and prolonged length of stay (>7 days). Long-term, all-cause 
      mortality was also measured. RESULTS: Sixteen patients died (3.49%). Risk factors 
      for mortality included a history of cerebrovascular disease (odds ratio [OR]: 
      4.51), New York Heart Association (NYHA) class 3 or 4 (OR: 8.88), and surgery on 
      the aorta or the aortic valve (OR: 5.74). Ninety-four patients suffered a major 
      adverse event (20.5%). Significant risk factors were male gender (OR: 2.28), NYHA 
      class of 3 or 4 (OR 2.58), 2 concomitant major operations (OR: 2.15), and 
      cardiopulmonary bypass time of greater than 100 minutes (OR: 3.18). Last, 90 
      patients (19.7%) remained in the hospital longer than 7 days. Significant risk 
      factors for a prolonged length of stay included chronic lung disease (OR: 3.05), 
      NYHA class of 3 or 4 (OR: 3.69), surgery by an adult cardiac surgeon (OR 2.58), 2 
      concomitant major operations (OR: 3.28), and cardiopulmonary bypass time of 
      greater than 100 minutes (OR: 2.41). Survival at 1, 5, and 10 years was 97.6%, 
      95.2%, and 93.4%, respectively. CONCLUSIONS: Surgery in adults with congenital 
      heart disease can be performed with low morbidity and mortality. Nonetheless, 
      there remain important risk factors for adverse events. Awareness and 
      modification of risk factors may help improve outcomes.
CI  - Copyright (c) 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Kogon, Brian
AU  - Kogon B
AD  - Department of Cardiothoracic Surgery, Emory University School of Medicine, 
      Atlanta, Georgia 30322, USA. bkogon@emory.edu
FAU - Grudziak, Joanna
AU  - Grudziak J
FAU - Sahu, Anurag
AU  - Sahu A
FAU - Jokhadar, Maan
AU  - Jokhadar M
FAU - McConnell, Michael
AU  - McConnell M
FAU - Book, Wendy
AU  - Book W
FAU - Oster, Matthew
AU  - Oster M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20130222
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - *Cardiac Surgical Procedures
MH  - Female
MH  - Follow-Up Studies
MH  - Georgia/epidemiology
MH  - Heart Defects, Congenital/mortality/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Morbidity/trends
MH  - Odds Ratio
MH  - Postoperative Complications/*epidemiology
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Young Adult
EDAT- 2013/03/07 06:00
MHDA- 2013/05/15 06:00
CRDT- 2013/03/07 06:00
PHST- 2012/09/29 00:00 [received]
PHST- 2012/11/11 00:00 [revised]
PHST- 2012/11/19 00:00 [accepted]
PHST- 2013/03/07 06:00 [entrez]
PHST- 2013/03/07 06:00 [pubmed]
PHST- 2013/05/15 06:00 [medline]
AID - S0003-4975(13)00085-4 [pii]
AID - 10.1016/j.athoracsur.2012.11.076 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2013 Apr;95(4):1377-82; discussion 1382. doi: 
      10.1016/j.athoracsur.2012.11.076. Epub 2013 Feb 22.