25-year mortality after surgical repair of congenital heart defect in childhood: a population-based cohort study

Article Abstract:

Advances in surgical techniques have greatly altered the prognosis for children who have heart defects. Thirty or forty years ago, many children with such defects did not live to adulthood. Now, most undergo surgical repair during childhood and do reach adulthood. This study examined the 25-year mortality for persons who had surgical repair of a heart defect in childhood. Data were obtained for individuals who underwent reparative surgery for one of eight congenital heart defects before the age of 18 years between 1958 and 1989 in Oregon. A total of 2,701 subjects underwent such surgery during this time period; the results reported in this study are based on the follow-up of 94 percent of this group. Operative mortality occurred in 22 percent of patients who had simple transposition of the great arteries, in 11 percent who had tetralogy of Fallot, and in less than 7 percent who had other abnormalities. These rates were significantly lower for those operated on in the last five years, with an operative mortality of 7 percent for transposition of the great arteries and 3 percent or less for the other abnormalities. Late cardiac mortality (at 25 years after surgery) was 5 percent for those who were operated on for tetralogy of Fallot, isolated ventricular septal defect (VSD), or pulmonic stenosis. It was 17 percent for aortic stenosis and 10 percent for coarctation of the aorta. For transposition of the great arteries, two rates were calculated because of the different surgical procedures used to treat it. Late cardiac mortality at 15 years was 15 percent for those who underwent the Mustard operation; the rate was 2 percent at 10 years for those who underwent the Senning procedure. These results indicate significant improvement in mortality of children with certain congenital heart defects. However, predictions of future mortality can not be based on these data. Cardiac surgery is now performed in younger children who have suffered less cardiac disease, and surgical techniques continue to improve. Long-term studies, such as the current report, help to identify specific patient groups who need intense follow-up care and determine how to further decrease mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Heart, Congenital heart disease in children, Cardiovascular abnormalities

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Indications, outcomes, and provider volumes for carotid endarterectomy

Article Abstract:

Post-operative mortality rates in patients who have carotid endarterectomy may vary depending on how many of these procedures hospitals have performed. This operation removes fatty plaque from the inside of carotid arteries to reduce the risk of stroke. A review of 678 patients who had the operation in Ohio hospitals found that 5% had a stroke or died within 30 days of the operation. The risk of stroke or death within 30 days was about 70% lower in hospitals that performed the most procedures. Almost half of the patients did not have symptomatic carotid artery disease prior to surgery.

Health aspects, Carotid artery diseases, Endarterectomy

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Thirty-year incidence of infective endocarditis after surgery for congenital heart defect

Article Abstract:

Patients who have surgery to correct congenital heart disease have an increased risk of developing endocarditis. Endocarditis is a bacterial infection of the heart valves. Researchers analyzed the medical and autopsy records of 3,860 people who had had surgery for congenital heart disease since 1958. Surgery for aortic valve stenosis appeared to be the greatest risk factor for endocarditis, which developed in 13% of the patients with this disease. For most other conditions, the incidence of endocarditis sometime within 25 years after surgery was less than 10%.

Statistics, Congenital heart disease, Endocarditis

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