Abstract 10945: Impact of Natural or Postoperative Survival Patterns in Long-term Outcome of Adult Survivors With Congenital Heart Disease
Background: Life expectancy of adult survivors with congenital heart disease (CHD) is related to CHD complexity but impact of natural or postoperative survival patterns on long-term outcome have not been reported.
Methods: In a prospective cohort of 3,334 adults (50.6% males) with CHD, followed up to 24 years in a single tertiary centre, we analyzed all-cause mortality, annual death rate, median age of survival (MAS) and standardized mortality ratio (SMR). Data provided by the Spanish national death index were used for mortality analysis. Lesions were classified into 3 groups according to CHD complexity: simple (1,647); moderate (1,283); and severe (404). Patients were then classified into 4 subgroups according to survival pattern: repaired in childhood (1,377); repaired in adulthood (759); CHD that did not require operation (1,035); and inoperable CHD (163).
Results: Median age at first examination was 22 years (IQ range 18-39) and median follow-up time 10.6 years (1-18). At the end of the study 336 patients had died (prevalence 10%; annual death rate 0.89%). In inoperable patients the estimated MAS was significantly lower (48.9 yrs; 95% CI 44-53), but there were not significant differences in MAS between patients repaired in childhood (75.9 yrs), repaired in adulthood (76.0 yrs) or that did not require repair (77.5 yrs). SMR in this latter group was 1.70 (95% CI 1.3-2.1)] but patients repaired in adulthood, repaired in childhood or inoperable had an increased SMR of 2.06 (95% CI 1.7-2.5), 5.87 (95% CI 4.5-7.7) and 24.1 (95% CI 18-33) respectively. The table shows a classification of long-term outcome depending on CHD complexity and survival pattern.
Conclusion: Adult survivors that do not require intervention and patients with repaired simple CHD have excellent life-long prognostic indexes. Excess mortality was demonstrated in repaired moderately complex CHD . Patients with CHD of great complexity have the worst prognosis, especially those that are inoperable.
Author Disclosures: P. Gallego: None. J.M. Oliver: None. A.E. Gonzalez Garcia: None. D. Garcia Hamilton: None. R. Yotti Alvarez: None. I. Ferreira Gonzalez: None. F. Fernandez Aviles: None.
- © 2015 by American Heart Association, Inc.