Successful surgical correction of congenital heart disease in adults: seven years' experience.
BACKGROUND
The long term consequences of untreated or residual/recurrent lesions pose unique challenges in the growing population of adults with congenital heart disease (CHD). This study summarizes the results of the surgical treatment of these patients.


METHODS
From October 1997 to October 2004, 289 patients with CHD, aged 18-72 (35+/-13.6) years, 143 men and 146 women, presented for surgery to our unit. Thirty eight patients (13.15%) had 1 to 3 prior surgical procedures. Although 137 patients (47%) were asymptomatic (NYHA I), 117 (40.5%) had mild (NYHA II), 34 (11.7%) moderate (NYHA III) and 1 (0.3%) severe (NYHA IV) symptoms. Thirty four patients had an established arrhythmia, requiring treatment in 25 (8.6%). Chromosomal anomalies were identified in 10 (3.4%) and diagnostic catheterization was required in 178 (61.5%) patients. All patients underwent complete surgical correction and in 275 (95%) of them this was performed with cardiopulmonary bypass of 107+/-74 min mean duration.


RESULTS
There was 1 early death (0.34%) due to embolic stroke related to atrial fibrillation (AF). Complications occurred in 50 patients (17%) and included re-operation for bleeding (5), stroke (3), pneumothorax (12), AF (22), complete heart block requiring permanent pacemaker implantation (2), wound dehiscence (1), pericardial (7) or pleural (3) effusion requiring drainage and peripheral neuropathy (1). Median intensive care unit and hospital stay was 1 (range 1-10) and 8 (range 5-42) days respectively. Two late deaths (0.7%) occurred in patients with AF and pulmonary hypertension. At mean follow-up of 45+/-24 (range 1-82) months all other patients are well with resolution or significant improvement in their symptoms.


CONCLUSIONS
Despite the long term deleterious effects of CHD in adult patients, surgical correction can be achieved with low mortality and acceptable morbidity. All deaths and most significant complications are related to arrhythmias.
Chatzis
Andrew C
AC
Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece. achatzis@otenet.gr
Giannopoulos
Nicolaos M
NM
Tsoutsinos
Alexandros I
AI
Chryssostomidis
Grigorios
G
Panagiotou
Chryssa
C
Zavaropoulos
Prodromos
P
Kirvasilis
George
G
Sarris
George E
GE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome