Surgery for Congenital Heart Disease Improves Survival and Heart Failure Class


PHILADELPHIA — Surgical management of congenital heart disease in adults resulted in high midterm survival rates, based on a review of more than 800 patients treated in Italy.

The actuarial 5-year survival rate was more than 90%, Dr. Massimo A. Padalino said at the annual meeting of the American Association for Thoracic Surgery. Overall freedom from any adverse effect was about 88%.

Outcomes were even better for patients who were acyanotic at the time of their surgery, with 91% of the acyanotic patients free from any adverse events in a 5-year actuarial analysis, said Dr. Padalino, a cardiac surgeon at the University of Padua.

The Italian review included 856 patients aged 18 years or older (average age 37) with congenital heart disease. The patients underwent surgery during 2000–2004 at one of seven Italian heart centers. The most common abnormality—seen in 27% of patients—was an atrial septal defect.

All patients had some level of heart dysfunction, with 35% rated as New York Heart Association (NYHA) class I, 48% with class II disease, 14% with class III disease, and 3% diagnosed as class IV.

Of the 1,179 surgical procedures performed during the 5 years of the study, 70% were repairs, 28% were reoperations, and 2% were palliative procedures. Closure of an atrial septal defect accounted for 36% of all procedures.

During the first 30 days after surgery, 3% of patients died. Follow-up data, averaging 22 months in duration, were available for 87% of patients. Late deaths occurred in fewer than 1% of patients.

Following surgery, 79% of patients had NYHA class I disease, 18% had class II disease, 2% had class III disease, and only one patient had class IV disease, Dr. Padalino said.

This compilation of data from multiple centers provides helpful information because single-center experiences usually involve too few patients for a detailed analysis, commented Dr. Hillel Laks, professor of surgery at the University of California, Los Angeles. The data are also important because the number of adults with congenital heart disease is growing: Dr. Laks estimated that about 800,000 of these patients are now in the United States.


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