Progress in Late Results Among Pediatric Cardiac Surgery Patients: A Population-Based Six-Decade Study with 98% Follow-Up
Background—Surgical treatment of congenital cardiac defects in Finland started over 60 years ago. We analyzed the survival of all the pediatric cardiac surgery patients operated on before 2010.
Methods and Results—Data was obtained retrospectively from a pediatric cardiac surgery database. Patient status was received from the Finnish population registry. Survival was determined using the Kaplan-Meier method, and the survival rate was compared to a sex- and age-matched general population. Between 1953 and 2009, 13,786 cardiac operations were performed on 10,964 pediatric patients in Finland. Follow-up coverage was 98%. The 60-year survival for the entire study was 70% versus 86% for the general population. The number and proportion of severe cardiac defects increased in the 2000s. The long-term survival of patients with severe defects improved significantly across decades. For instance the 22-year survival of patients with transposition of the great arteries operated on 1953-89 and 1990-2009 improved from 71% to 93% (hazard ratio for death, 0.29; 95% confidence interval [CI], 0.17 to 0.49; P<0.0001), respectively. The mean patient age at operation decreased from 8.9 to 2.2 years (95% CI, 6.2 to 7.1, P<0.0001). The early mortality of patients decreased from a maximum of 7% in the 1970s to 3% in the 2000s (95% CI, 0.05 to 0.08, P<0.0001).
Conclusions—Patients are diagnosed and treated at an increasingly younger age. Advanced diagnostics, surgical methods and post-operative intensive care have led to substantial improvements in both early- and late results among pediatric cardiac surgery patients.
- Pediatric cardiac surgery
- true survival
- congenital cardiac defect
- cardiac surgery
- Received May 19, 2014.
- Revision received November 6, 2014.
- Accepted November 13, 2014.