Key result
Contemporary treatment of congenital heart diseases in adults (2007-2015) compared to historical treatment (1987-1997) was associated with a reduction in postoperative mortality from 3.3% to 1% and a decrease in surgical refusal rates from 28.8% to 3.7%.
Why the study?
Does contemporary surgical and transcatheter management improve treatment rates and reduce mortality in adults with congenital heart disease compared to historical practices?
Observational (n=946)
No
Does contemporary surgical and transcatheter management improve treatment rates and reduce mortality in adults with congenital heart disease compared to historical practices?
Absolute Event Rate: 1% vs 3.3%
Advances in cardiac surgery and the introduction of transcatheter techniques have significantly increased the operability and reduced the mortality of adults with congenital heart disease over the last 15 years.
Aim. To summarize and to distinguish the features of diagnosis and treatment of congenital heart diseases in adults characteristic for the contemporary cardio surgery, by a retrospective study of case reports. Methods. The study analyzed the medical charts of 245 adults with congenital heart diseases treated in the Cardio surgical department №2 of the Interregional Clinical and Diagnostic Center between 2007 and 2015 years. The comparison group included 701 adult patients with congenital heart diseases treated in the Kazan Center of Cardiovascular surgery between 1987 and 1997. Results. The prevalence of congenital heart diseases in adults remains significant. In recent years, the share of operations for these diseases is 5.4% of all cardiac interventions. The most frequent pathology is atrial septal defects. The most frequent complications of septal defects are tricuspidal valve insufficiency (83%) and pulmonary hypertension (77%). Comorbidities include: hypertensive heart disease (36%), cardiac arrhythmias (31%) and ischemic heart disease (33%). The number surrendered surgeries decreased from 28.8% in 1997 to 3.7% in 2014. Postoperative mortality has decreased from 3.3% to 1%. Nowadays a significant amount of operations (56%) is transcatheter occlusion. There is an experience of such surgeries in defects of secondary atrial septum and patent ductus arteriosus. Conclusion. Congenital heart diseases in adults are characterized by severe impairment of haemodynamics, leading to arterial pulmonary hypertension and tricuspid insufficiency, therefore, require early diagnostics and timely treatment before the onset of complications. 68% of such adult patients suffer from comorbidities that increase the risk of surgical interventions. Endovascular surgeries are low invasive, have minimal complication rate and produce good immediate and long-term results.
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Dzhordzhikiya et al. (2015) conducted an observational in Congenital heart diseases in adults (n=946). Contemporary cardio-surgical treatment (2007-2015) vs. Historical cardio-surgical treatment (1987-1997) was evaluated on Postoperative mortality. Contemporary treatment of congenital heart diseases in adults (2007-2015) compared to historical treatment (1987-1997) was associated with a reduction in postoperative mortality from 3.3% to 1% and a decrease in surgical refusal rates from 28.8% to 3.7%.
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