[Adult congenital heart program in a tertiary care facility of pediatric cardiology].
BACKGROUND
Owing to excellent survival following primary repair over 80% of congenital cardiac patients reach adulthood, half of them requiring continuous specialist care and one-third needing further reoperation. The ample variety and complexity of lesions warrant individualised treatment strategy.


OBJECTIVE
This study focuses on grown-up congential heart (GUCH) programme in the settings of a tertiary pediatric cardiac centre.


METHODS
Patients underwent corrective surgical procedures in pediatric facilities (theatre, ICU, wards) with a close involvement of adult cardiology/anaesthetic team. Patients were divided into simple/complex groups.


RESULTS
Simple group of comprised patients (n = 20) having ASD-II (18/20) sinus venosus ASD (2/20) repair without morbidity/mortality from right subaxillary thoracotomy in 17/20. Complex group (n = 20): corrective surgery for tetralogy of Fallot (6), LVOT-aortic valve repairs (4), allograft conduit exchange (3), TCPC (3), miscellaneous procedures (4) were performed as reoperations in 16/20 at 16.1 +/- 8.1 years following previous operations (median: 1.96, range 1-4). Postoperative right ventricle- (1), acute renal (1) failure and ARDS (1) fully recovered. One patient was lost for multi-organ-failure due to low cardiac output syndrome caused by chronic RV failure. Preoperative cyanosis was a risk factor for postoperative complications (p = 0.01). All survivors are symptom-free. No significant difference in ITU stay/LOS was observed between simple and complex groups.


CONCLUSIONS
This study represents the initial experience of authors with GUCH. The number of GUCH patients is expected to rise with an upgrade shift in surgical complexity and severity requiring a multidisciplinary approach. It is advocated that complex GUCH cases should be performed by teams experienced in congenital reconstructive surgery. Patients following complex GUCH procedures have a comparable hospital course to patients undergoing simple cardiac operations.
Király
László
L
Gottsegen György Országos Kardiológiai Intézet, Gyermekszív Központ, Budapest. kiraly@kardio.huj
Temesvári
András
A
Székely
Andrea
A
Prodán
Zsolt
Z
Liptai
Csilla
C
Szudi
László
L
Hartyánszky
István
I
Havrancsik
Csilla
C
Szatmári
András
A
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D012307:Risk Factors; D013908:Thoracotomy; D016896:Treatment Outcome