Authors : Pavlovic , Jean-Pierre Pfamma and Thierry Carrel
Abstract: To assess early results and identify perioperative risk factors in grown-ups with congenital heart disease (GUCH) needing primary or redo cardiac surgery. Perioperative outcome of 296 consecutive GUCH patients (mean age 35 ?16 (14-72) years) needing primary (230 pts, group 1) or redo surgery (66 pts, group 2) was analysed. Most frequent initial cardiac defects were ASD (49%), LVOT pathology (23.3%), Marfan syndrome (7.4%) andcoarctation (6.1%). Closure of ASD or VSD (54.7%), aortic valve procedures (34.5%) and aortic replacement (12.2%) were the most frequent performed. Durations of surgical repair, CPB, aortic cross- lamping and hypothermic circulatory arrest (HCA) were all significantly longer and core temperature lower in group 2 than 1 (all p<.0001). Early mortality was 3.4%, but was significantly higher in group 2 than 1 (7.6% vs. 2.2%; p=.04). Significant postoperative complications occurred in 30% and were more frequent in group 2 (42.4%) than 1 (26.5%; p=.01), especially multi-organ failure (MOF) (p=.015), low output failure (LOF) (p=.04), respiratory complications (p=.0009), renal failure (p<.0001) andtotal av-block (p=.04). MOF, LOF, HCA and respiratory complications were independent predictors for fatal outcome. Surgery in GUCH patients is mostly performed due to ASD, outflow tract lesions, Marfan syndrome and coarctation. First operations have an excellent outcome, whereas re-operations still have increased mortality and morbidity and particular risk factors. Therefore, close follow-up, timely referral for re-intervention and aggressive perioperative monitoring are mandatory to reduce perioperative risks and improve results in these patients.
Pavlovic , Jean-Pierre Pfamma and Thierry Carrel , 2005. Early Out come in Guch Surgery A. Pascal, Berdat, Nicolas Trost, Mladen . The Cardiology, 1: 87-94.