Factors determining outcomes in grown up patients operated for congenital heart diseases.
BACKGROUND
The number of grown ups with congenital heart diseases (GUCHs) is steadily increasing.


OBJECTIVE
To analyze factors predicting early cardiac morbidity following cardiac surgery in GUCH at a tertiary care center.


METHODS
Retrospective study at a multispeciality tertiary referral center.


METHODS
Between January 2004 and December 2014, 1432 patients ≥13 years of age (acyanotic defects: 843, cyanotic defects: 589) underwent surgery for congenital heart defects. Factors associated with early cardiac morbidity were analyzed.


METHODS
Univariable and multivariable analysis of all factors affecting outcomes.


RESULTS
On multivariate analysis, previous sternotomy, aortic cross-clamp time >45 min, cyanosis, and emergency procedure were independent predictors of early morbidity with respective odds ratios (ORs) of 12.4, 3.6, 2.6, and 8.1. For more precise estimation, a risk score was generated. Taking the log odds with each of these four as respective weights, a score was generated. The variables were previous sternotomy (2.5), aortic cross-clamp >45 min (1.3), emergency procedure (2.1), and cyanosis (0.9), if the respective condition is present, zero otherwise. The score ranged from 0 to 4.5. The average value of the score based on the four variables was significantly higher in cases with morbidity (1.85 ± 1.17) vs. (0.75 ± 0.88), P < 0.001. Distribution of scores was significantly different between patients with and without morbidity. Sixty-seven percent patients without any morbidity had score <1 compared to 24.6% with morbidity. Only 0.9% patients without morbidity had score of ≥3 compared to 16.4% patients with morbidity. Compared with patients having score <1, patients with scores 1-2 had OR of 3.4, 2-3 had OR of 6.0, and >3 had OR of 48.7.


CONCLUSIONS
GUCH can be safely operated when adequate caution is taken in the presence of independent predictors such as previous sternotomy, aortic clamp time >45 min, cyanosis, and emergency procedure.
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Sachin
S
Talwar
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Manikala V
MV
Kumar
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Vishnubhatla
V
Sreenivas
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Shiv K
SK
Choudhary
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Manoj
M
Sahu
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Balram
B
Airan
Congenital heart disease in adults; delayed diagnosis; grown up congenital heart disease; reoperations