Objective

Transcatheter interventional strategy for management of adults with congenital heart disease (ACHD) is increasingly the preferred invasive treatment option. Recently, several techniques have been developed towards this. We aim to assess the impact of these procedures on the management of ACHD.


Methods

Retrospective study of ACHD patients (age≥18yrs), who underwent cardiac catheterisation (CC) from January 2000 to December 2008. Data collected included diagnosis, type of procedure and complications.


Results

1784 (54% women) ACHD patients underwent CC (mean age 42±14.5 years). 19% had diagnostic and the rest, interventional procedures.
The majority were ASD and PFO closures (82%) with a major complication rate of <2.5% (ASDs). The other procedures in descending frequency were: aortic coarctation stenting, VSD closure, PDA embolization, pulmonary valvuloplasty, pulmonary artery stenting and others. There was only 1 death. Over the last 9-years, the number of patients undergoing surgery was constant (~80/year) but the numbers of those undergoing interventional CC increased steadily from 100/yr in 2000 to >225 in 2008.


Conclusion

The evolving use of interventional catheterisation in ACHD has major implications on healthcare organizations for providing optimal care, especially for patients with complex lesions. Increasingly, ACHD with simpler lesions are being managed by interventional catheterisation, hence the percentage of complex cases for surgery is increasing. Hopefully, new developments like transcutaneous valves & hybrid procedures will help to lessen this surgical load.
In conclusion, we believe that the interventional treatment option for ACHD is safe, successful and will have a wide-ranging impact on patients and healthcare agencies.