title: [Risk factors for surgery of congenital heart disease in adults: twenty-two years of experience. Who should operate them?].
abstract: OBJECTIVE
  To assess the association between mortality in surgery of congenital heart disease in adults, and factors related to patients and operations.
  
  
  METHODS
  Descriptive study of operations performed by specialized surgeons in congenital heart surgery (238), adult acquired surgery (117), and specialty residents (108). The association of mortality with surgical risk and complexity, specialization of surgeon, cardiopulmonary by-pass and aortic cross clamping was assessed fitting logistic regression models.
  
  
  RESULTS
  A total of 463 operations were included (442 with cardiopulmonary by-pass) in the study performed between 1991 and 2012. Median age at surgery: 34; 52.8% were women. First surgery: 295, reoperation: 168. Median score of Aristotle was 6.8, with significantly higher complexity since 2001, after restructuring the Unit. Overall hospital mortality was 3.9%. Mortality was significantly associated to number of previous surgeries (OR: 5.02; 95%CI: 1.44-17.52), operations by acquired heart disease surgeons (OR: 3.53; 95%CI: 1.14-10.98), higher Aristotle (OR: 1,64; 95%CI: 1.18-2.29), and high cardiopulmonary by-pass time (OR: 1.13; 95%CI: 1.07-1.19).
  
  
  CONCLUSIONS
  Surgery of congenital heart disease in adults has been performed with low mortality. High complexity interventions, prolonged cardiopulmonary by-pass times and multiple reoperations were associated to higher mortality. Participation of cardiac surgeons specialized in congenital heart disease is associated with better outcomes.
authors.affiliation: Servicio de Cirugía Cardíaca Infantil y Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España. Electronic address: aarocap@telefonica.net.
authors.forename: Angel
authors.initials: A
authors.lastname: Aroca
authors.affiliation: Servicio de Cirugía Cardíaca Infantil y Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España.
authors.forename: Luz
authors.initials: L
authors.lastname: Polo
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública (Historia de la Ciencia), Universidad Complutense de Madrid, Madrid, España.
authors.forename: Napoleón
authors.initials: N
authors.lastname: Pérez-Farinós
authors.affiliation: Servicio de Cardiología y Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España.
authors.forename: Ana E
authors.initials: AE
authors.lastname: González
authors.affiliation: Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, España.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Bret
authors.affiliation: Servicio de Cirugía Cardiovascular, Hospital Centenario Miguel Hidalgo, Aguascalientes, México.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Aguilar
authors.affiliation: Servicio de Cardiología y Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España.
authors.forename: José M
authors.initials: JM
authors.lastname: Oliver
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Adultos; Adults; Cardiac surgery; Cardiopatías congénitas; Cirugía cardíaca; Congenital heart defects; España; Factores de riesgo; Mortalidad; Mortality; Risk factors