title: Achievements in congenital heart defect surgery: a prospective, 40-year study of 7038 patients.
abstract: BACKGROUND
  This article presents an update of the results achieved by modern surgery in congenital heart defects (CHDs) over the past 40 years regarding survival and the need for reoperations, especially focusing on the results from the past 2 decades.
  
  
  RESULTS
  From 1971 to 2011, all 7038 patients <16 years of age undergoing surgical treatment for CHD at Rikshospitalet (Oslo, Norway) were enrolled prospectively. CHD diagnosis, date, and type of all operations were recorded, as was all-cause mortality until December 31, 2012. CHDs were classified as simple (3751/7038=53.2%), complex (2918/7038=41.5%), or miscellaneous (369/7037=5.2%). Parallel to a marked, sequential increase in operations for complex defects, median age at first operation decreased from 1.6 years in 1971 to 1979 to 0.19 years in 2000 to 2011. In total, 1033 died before January 1, 2013. Cumulative survival until 16 years of age in complex CHD operated on in 1971 to 1989 versus 1990 to 2011 was 62.4% versus 86.9% (P<0.0001). In the comparison of patients operated on in 2000 to 2004 versus 2005 to 2011, 1-year survival was 90.7% versus 96.5% (P=0.003), and 5-year cumulative survival was 88.8% versus 95.0% (P=0.0003). In simple versus complex defects, 434 (11.6%) versus 985 (33.8%) patients needed at least 1 reoperation before 16 years of age. In complex defects, 5-year cumulative freedom of reoperation among patients operated on in 1990 to 1999 versus 2000 to 2011 was 66% versus 73% (P=0.0001).
  
  
  CONCLUSIONS
  Highly significant, sequential improvements in survival and reductions in reoperations after CHD surgery were seen. A future challenge is to find methods to reduce the need for reoperations and further reduce long-term mortality.
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.). gunnar.erikssen@yahoo.com.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Erikssen
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Knut
authors.initials: K
authors.lastname: Liestøl
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Egil
authors.initials: E
authors.lastname: Seem
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Sigurd
authors.initials: S
authors.lastname: Birkeland
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Kjell Johan
authors.initials: KJ
authors.lastname: Saatvedt
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Tom Nilsen
authors.initials: TN
authors.lastname: Hoel
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Gaute
authors.initials: G
authors.lastname: Døhlen
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Helge
authors.initials: H
authors.lastname: Skulstad
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Jan Ludvig
authors.initials: JL
authors.lastname: Svennevig
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Erik
authors.initials: E
authors.lastname: Thaulow
authors.affiliation: From the Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E., H.S.); Department of Informatics, University of Oslo, Norway (K.L.); Department of Thoracic Surgery, Oslo University Hospital, Rikshospitalet, Norway (E.S., S.B., K.J.S., T.N.H., J.L.S., H.L.L.); and Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.D., E.T.).
authors.forename: Harald Lauritz
authors.initials: HL
authors.lastname: Lindberg
mesh_terms: D000124:Achievement; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: heart defects, congenital; reoperation; survival; thoracic surgery