Achievements in Congenital Heart Defect Surgery: A Prospective, 40 Year Study of 7038 Patients
Background—To update results achieved by modern surgery in congenital heart defects (CHD) over the last 40 years regarding survival and need for reoperations, especially focusing on the results from the two last decades.
Methods and Results—From 1971 to 2011, all 7038 patients under age 16 years undergoing surgical treatment for CHD at Rikshospitalet (Oslo, Norway) were enrolled prospectively. CHD-diagnosis, date and type of all operations were recorded, as was all-cause mortality until December 31.2012. CHDs were classified as "simple" (3751/7038 = 53.2%), "complex" (2918/7038 = 41.5%) or "miscellaneous" (369/7037 = 5.2%). Parallell to a marked, sequential increase in operations for complex defects, median age at first operation decreased from 1.6 years in 1971-1979 to 0.19 years in 2000-2011. In total, 1033 died prior to January 1, 2013. Cumulative survival until age 16 years in complex CHD operated in 1971-1989 vs. 1990-2011 was 62.4% vs. 86.9% (p< 0.0001). Comparing patients operated in 2000-04 vs. 2005-11, one year survival was 90.7% vs. 96.5% (p=0.003), and five year cumulative survival 88.8% vs. 95.0% (p=0.0003). In simple vs. complex defects, 434 (11.6%) vs. 985 (33.8%) needed at least one reoperation before age 16 years. In complex defects, five years cumulative freedom of reoperation among patients operated in 1990-1999 vs. 2000-2011 was 66% vs. 73% (p=0.0001).
Conclusions—Highly significant, sequential improvements in survival and reductions in reoperations after CHD surgery were seen. A future challenge is to find methods to reduce the need for reoperations and further reduce long term mortality.
- Received July 2, 2014.
- Revision received September 24, 2014.
- Accepted October 17, 2014.