title: Midterm results of surgery for adults with congenital heart disease centralized to a Swedish cardiothoracic center.
abstract: OBJECTIVE
  The surgical management of adults with congenital heart disease (ACHD) offers a great challenge, with a large number of anomalies with complex pathophysiology necessitating specific treatments. Pre- and postoperative morbidity has been relatively high, and the influencing factors are not completely identified. We sought to evaluate the incidence and predictors of postoperative complications following surgery for ACHD centralized to a Swedish cardiothoracic center.
  
  
  METHODS
  Between April 2003 and May 2012, 191 consecutive patients with ACHD underwent 192 surgical procedures at our department. Pre-, intra-, and postoperative data were prospectively entered in a clinical database and retrospectively reviewed. Multivariate analysis was used to identify determinants of postoperative complications as a composite end point.
  
  
  RESULTS
  The 30-day mortality was 0.5%. Overall survival was 98.3% ± 1.0 at 1 year and 98.3% ± 1.0 at 5 years postoperatively. Repeat sternotomy had to be performed in 94 patients (49%). New onset atrial fibrillation or flutter was the most prevalent (13%, n = 17/135) postoperative complication. Independent risk factors for major postoperative complications were age (odds ratio [OR] 1.81/10 year increment, P = 0.001; 95% confidence interval [CI] 1.29-2.53), reduced (<50%) systemic left ventricle ejection fraction (OR 3.61, P = 0.031; 95% CI 1.13-11.6), and the duration of cardiopulmonary bypass (OR 3.34/60 minute increase, P < 0.001; 95% CI 2.03-5.49).
  
  
  CONCLUSIONS
  Our present data suggest that surgery in ACHD can be performed in centralized units with an excellent early and midterm survival. The incidence of postoperative complications was relatively low consisting mainly of supraventricular arrhythmias. In our opinion, ACHD surgery should be performed in centralized units with experienced surgeons in a dedicated multidisciplinary team for optimized postoperative management.
authors.affiliation: Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden. shahab.nozohoor@med.lu.se
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
authors.forename: Ronny
authors.initials: R
authors.lastname: Gustafsson
authors.forename: Janica
authors.initials: J
authors.lastname: Kallonen
authors.forename: Johan
authors.initials: J
authors.lastname: Sjögren
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002497:Centralized Hospital Services; D016009:Chi-Square Distribution; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult