Surgical Outcome of Major Open Heart Surgery in Adults with Congenital Heart Disease

  • Dr R Suresh Kumar, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr Roy Varghese, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr G Ganesh Kumar, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr Suraj Varma, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr J Vimala, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr G Selvakumar, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr Udaycharan Murmu, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India
  • Dr John Valliatu, Dept of Pediatric Cardiology, ICVD, Madras Medical Mission, Chennai, India, India

    • Objective

    There is scanty data on the surgical outcome of complex congenital heart disease in adults. This is a retrospective study of Adult congenital heart disease (ACHD) patients in an Indian tertiary care centre with focus on surgical outcome of complex ACHD.

    Method

    Case records of 746 consecutive patients ≥ 21yrs who attended a Pediatric Cardiology/ACHD unit during the period June 2003 through August 2008 were reviewed retrospectively. 153 patients underwent open heart surgery. Atrial Septal Defect (Ostium secundum or Sinus venosus) closure was considered “simple” (Group A) while all the other open heart surgeries were considered “Major” (Group B). The results of intracardiac repair (ICR) for Tetralogy of Fallot were compared with those of 25 children who had the same surgery.

    Results

    There were 102 patients in Group A and 51 in Group B. Diagram I and Table I show diagnostic categories, demographic profile and outcome variables in the group.

    Outcome of ICR was comparable in adults (n=23) and children (n=25), but for one mortality (4%) and higher incidence of major complications (22% vs 7.1%).

    At a median follow up of 24 months, there was no late mortality. All patients were physically active and in NYHA class I or II. Two patients in Group A and one patient in Group B had major arrhythmias (AF/SVT).

    Conclusion

    In the current era, major open heart surgery can be performed in adults with low mortality and morbidity, even with the different disease profile in emerging economies.

    Variable Group A (n=102) Group B (n=51) p value
    Age (yrs) 33.4±9.1(M:F=37:65) 29.1±6.6(M:F=29:22) 0.004
    Weight (kg) 56.8 ± 12.9 52.7 ± 12.5 0.075
    Bypass time (min) 67.8 ± 26.4 127.2 ± 56.5 < 0.001
    Aortic x clamp time (min) 36.1 ± 21.5 79.9 ± 48.1 < 0.001
    ICU stay (days) 1.9 ± 1.2 4.1 ± 2.9 < 0.001
    Ventilation >24hrs 1(1%) 13(27.6%) < 0.001
    Complications 6(5.8%) 11(21.5%) 0.004
    Mortality Nil 2 (4%) 0.044