title: Cardiac medical conditions have become the leading cause of death in children with heart disease.
abstract: OBJECTIVE
  Mortality among children with congenital and acquired heart disease has decreased significantly over the past decades. We sought to determine whether the underlying problems leading to death in these patients had changed over the past decade.
  
  
  METHODS
  We reviewed medical records for 100 deaths of cardiac patients in 2004-2005 and 100 deaths in 1995-1996. Demographic, clinical, and procedural data as well as circumstances of death were collected. A consensus committee reviewed each case and sought to identify the condition leading to death. These conditions were classified as predominantly surgical or medical.
  
  
  RESULTS
  General patient characteristics (age, gender, cardiac history, comorbidities, proportion of surgical patients) did not change significantly between the two time periods. However, in 1995-1996, 64% of deceased surgical patients had died within 30 days of surgery. This rate was nearly halved to only 38% by 2004-2005 (P= .003). Furthermore, the conditions leading to death changed significantly: 51% of patient deaths in 1995-1996 resulted from a surgical problem, 29% from a medical condition. This ratio was reversed in 2004-2005: Only 31% of patient deaths were due to a surgical problem, while 50% of deaths resulted from a medical condition (P= .005). The most common medical conditions resulting in death were pulmonary vein stenosis, pulmonary arterial hypertension, and primary myocardial failure.
  
  
  CONCLUSIONS
  The proportion of deaths within 30 days of cardiac surgery decreased significantly over the past decade. While surgical causes accounted for the majority of these deaths in 1995-1996, most patient deaths in 2004-2005 resulted from cardiac medical causes.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Mass, USA.
authors.forename: Tobias R
authors.initials: TR
authors.lastname: Schlingmann
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Lofgren
authors.forename: Michael
authors.initials: M
authors.lastname: Zaplin
authors.forename: Jean A
authors.initials: JA
authors.lastname: Connor
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001900:Boston / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D015897:Comorbidity; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000601:surgery; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011668:Pulmonary Veno-Occlusive Disease / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult