Objectives

Mortality in infants with cardiovascular malformations (CVMs) may be due to cardiac defects, their treatment or non-cardiac causes. We investigated causes of death in infants with CVMs, and contribution of “surgical” mortality to total infant mortality over 20 years.

Methods

We obtained details of all deaths of infants with CVMs in the Northern Region of England. Two independent panels reviewed anonymised data and categorised the cause of death as non-cardiac, non-surgical or surgical.

Results

In 1987-2006 there were 676,927 live-births in the population. Total infant mortality fell from 8.1 to 4.9 per 1000. CVMs were found in 4652 infants (6.9 per 1000) and 464(10%) died before age 12 months. Of these 103(22%) had a chromosomal abnormality and 78(17%) had a major non-cardiac malformation. Infant mortality with a CVM decreased from 23% in 1987 to 5% in 2006.
Of 464 deaths, 152(32%) were non-cardiac, 148(32%) non-surgical, 37(8%) intra-operative, 106(23%) post-operative, and 21(5%) late and sudden. Median age at death was 27 days (0-390). Death was non-cardiac in 60(58%) infants with a chromosomal abnormality, 42(54%) with a non-cardiac malformation and 52(18%) with isolated CVM.
225/464(49%) who died underwent intervention. “Surgical” mortality was 10/75(13%) operations in 1989 compared with 3/172(2%) in 2006. The contribution of “surgical” mortality to total mortality fell from 10/32(31%) to 3/14(21%) in that time.

Conclusions

Mortality in live born infants with CVMs has declined over 20 years. The majority of deaths in infants with a chromosomal or major non-cardiac malformation are non-cardiac in origin. Surgical mortality declined markedly.