title: Adult congenital cardiac surgery in Indonesia.
abstract: BACKGROUND
  Successful paediatric cardiac surgery and cardiology treatment has resulted in an increase in the use of surgery as a method of treatment of congenital cardiac disease in adult population. However, late detection and lower socio-economic condition in developing countries might change patients' characteristics by the time they come for treatment. This study aimed to elaborate the long-term surgical results of adult congenital cardiac disease in Indonesia as a developing country.
  
  
  RESULTS
  We reviewed retrospectively all adult congenital cardiac disease patients with a mean age of 28 years plus or minus 9.5 years, who underwent surgery at National Cardiovascular Center. The types of procedures used were corrective in 338 patients (89.2%), palliative in 10 patients (2.6%), and re-operations in 31 patients (8.2%). The overall hospital mortality rate was 2.6% but as high as 20% with palliative surgery. Post-operative New York Heart Association class III-IV is the only independent predictor of death at 60 months (hazard ratio 61.48, 95% confidence interval 9.41-401.69, p<0.001). The survival rates were 96.3% and 95% for overall and non-atrial septal defect in patients at 60 months, which was highest in corrective procedures (97.6%). The percentage of patients free of re-operation at 5 years' follow-up was 85.4% and 42.7% at 10 years.
  
  
  CONCLUSIONS
  In developing countries, surgical treatment of adult congenital cardiac disease is effective and safe, with an overall survival rate of 96.3% at 60 months. Due to high mortality rate, palliative surgery of a non-atrial septal defect patient is recommended to be discontinued. The independent predictor of mortality was post-operative New York Heart Association functional class III-IV.
authors: Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors: Karina V
authors: KV
authors: Wilamarta
authors: Yoga
authors: Y
authors: Yuniadi
authors: Jusuf
authors: J
authors: Rachmat
authors: Dicky
authors: D
authors: Fakhri
authors: Tarmizi
authors: T
authors: Hakim
authors: Maizul
authors: M
authors: Anwar
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult