Survival after surgery for congenital heart defects: does reduced early mortality predict improved long-term survival?
OBJECTIVE
The objectives of this study were 1) to compare early mortality (first 30 d after surgery) and long-term survival between two cohorts of patients operated on for congenital cardiac defects, and 2) to evaluate the impact of possible changes in early mortality on long-term survival.


METHODS
945 patients with congenital cardiac defects, born in 1990-1999 and operated on in the same period were examined in a retrospective cohort study. The patients were divided into three groups: "univentricular cardiac defects", "severe cardiac defects" and "less severe cardiac defects". The study population was divided into two cohorts: group 1 included patients born and operated on in 1990-1994; group 2 included patients born and operated on in 1995-1999. The survival patterns in the two groups were compared.


RESULTS
For all patients, except those with univentricular cardiac defects, early mortality (30 d after surgery) was reduced. Among patients with severe cardiac defects, early mortality was reduced from 18.6% in group 1 to 2.9% in group 2. Among patients with less severe cardiac defects, early mortality was reduced from 6.2% to 1.9%. The improved outcome was maintained during the following 5 y. Overall relative risk of death during follow-up was reduced to 0.31 (95% CI: 0.15-0.56) for patients with severe cardiac defects, and to 0.53 (95% CI: 0.31-0.93) for patients with less severe cardiac defects born and operated on in 1995-1999.


CONCLUSIONS
Early mortality has been substantially reduced in congenital heart defect patients, and corresponds with significantly improved long-term survival.
Eskedal
Leif
L
Department of Paediatrics, Sørlandet Hospital, Kristiansand, Norway. leif.eskedal@sshf.no
Hagemo
Peter Skjalg
PS
Eskild
Anne
A
Aamodt
Geir
G
Seiler
Kerry S
KS
Thaulow
Erik
E
D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate