title: Contemporary cardiac surgery for adults with congenital heart disease.
abstract: Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery.
  
  
  
  This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011. Early mortality was the primary outcome measure. Midterm to longer-term survival, cumulative incidence of reoperation, other interventions and/or new-onset arrhythmia were secondary outcome measures. Predictors of early/total mortality were identified.
  
  
  
  Age at surgery was 35±15 years, 53% male, 52.3% were in New York Heart Association (NYHA) class I, 37.2% in class II and 10.4% in class III/IV. Early mortality was 1.77% with independent predictors NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm and female gender. Over a mean follow-up of 2.8±2.6 years, 46 patients died. Baseline predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm and non-elective surgery. The number of sternotomies was not independently associated with neither early nor total mortality. At 10 years, probability of survival was 94%. NYHA class among survivors was significantly improved, compared with baseline.
  
  
  
  Contemporary cardiac surgery for ACHD performed at a single, tertiary reference centre with a multidisciplinary approach is associated with low mortality and improved functional status. Also, our findings emphasise the point that surgery should not be delayed because of reluctance to reoperate only.
authors.affiliation: Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.|Department of Adult Cardiac Surgery, Saint Joseph Hospital, Marseille, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Beurtheret
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Oktay
authors.initials: O
authors.lastname: Tutarel
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
authors.forename: Gerhard Paul
authors.initials: GP
authors.lastname: Diller
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: West
authors.affiliation: Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Ntalarizou
authors.affiliation: Department of Biostatistic and Public Health, La Timone Hospital, Marseille, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Resseguier
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Papaioannou
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Jabbour
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Simpkin
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bastin
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
authors.forename: Sonya V
authors.initials: SV
authors.lastname: Babu-Narayan
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Bonello
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.
authors.forename: Babulal
authors.initials: B
authors.lastname: Sethia
authors.affiliation: Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.
authors.forename: Hideki
authors.initials: H
authors.lastname: Uemura
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.|NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.affiliation: Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.
authors.forename: Darryl
authors.initials: D
authors.lastname: Shore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: adults – congenital heart disease – cardiac surgery