Midterm results of surgical intervention for congenital heart disease in adults: an Italian multicenter study.
OBJECTIVE
We have analyzed, in a clinical multicenter study, the effect of cardiac surgery in adults with congenital heart disease in Italy.


METHODS
We collected clinical data from 856 patients aged 19 years or older who underwent surgical intervention from January 1, 2000, to December 31, 2004. Patients were divided into 3 surgical groups: group 1, palliation (3.1%); group 2, repair (69.7%); and group 3, reoperation (27.4%).


RESULTS
Preoperatively, 34.6% of patients were in New York Heart Association class I, 48.4% were in class II, 14.2% were in class III, and 2.8% were in class IV. Sinus rhythm was present in 83%. There were 1179 procedures performed in 856 patients (1.37 procedures per patient), with a hospital mortality of 3.1%. Overall mean intensive care unit stay was 2.3 days (range, 1-102 days). Major complications were reported in 247 (28.8%) patients, and postoperative arrhythmias were the most frequent. At a mean follow-up of 22 months (range, 1 month-5.5 years; completeness, 87%), late death occurred in 5 (0.5%) patients. New York Heart Association class was I in 79.3%, II in 17.6%, and III in 2.9%, and only 1 (0.11%) patient was in class IV. Overall survival estimates are 82.6%, 98.9%, and 91.8% at 5 years for groups 1, 2, and 3, respectively. Freedom from adverse events at 5 years is 91% for acyanotic patients versus 63.9% for preoperative cyanotic patients (P < .0001).


CONCLUSIONS
Surgical intervention for congenital heart disease in adults is a safe and low-risk treatment. However, patients presenting with preoperative cyanosis show a higher incidence of late adverse events and complications.
Padalino
Massimo A
MA
Pediatric and Congenital Cardiac Surgery Unit, Centro Gallucci, University of Padua Medical School, Padua, Italy.
Speggiorin
Simone
S
Rizzoli
Giulio
G
Crupi
Giancarlo
G
Vida
Vladimiro L
VL
Bernabei
Massimo
M
Gargiulo
Gaetano
G
Giamberti
Alessandro
A
Santoro
Francesco
F
Vosa
Carlo
C
Pacileo
Giuseppe
G
Calabrò
Raffaele
R
Daliento
Luciano
L
Stellin
Giovanni
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D003625:Data Collection; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome