Trends in Long-Term Mortality After Congenital Heart Surgery

Logan G. Spector, Jeremiah S. Menk, Jessica H. Knight, Courtney McCracken, Amanda S. Thomas, Jeffrey M. Vinocur, Matthew E. Oster, James D. St Louis, James H. Moller, Lazaros Kochilas

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Congenital heart surgery has improved the survival of patients with even the most complex defects, but the long-term survival after these procedures has not been fully described. Objectives: The purpose of this study was to evaluate the long-term survival of patients (age <21 years) who were operated on for congenital heart defects (CHDs). Methods: This study used the Pediatric Cardiac Care Consortium data, a U.S.-based, multicenter registry of pediatric cardiac surgery. Survival analysis included 35,998 patients who survived their first congenital heart surgery at <21 years of age and had adequate identifiers for linkage with the National Death Index through 2014. Survival was compared to that in the general population using standardized mortality ratios (SMRs). Results: After a median follow-up of 18 years (645,806 person-years), 3,191 deaths occurred with an overall SMR of 8.3 (95% confidence interval [CI]: 8.0 to 8.7). The 15-year SMR decreased from 12.7 (95% CI: 11.9 to 13.6) in the early era (1982 to 1992) to 10.0 (95% CI: 9.3 to 10.8) in the late era (1998 to 2003). The SMR remained elevated even for mild forms of CHD such as patent ductus arteriosus (SMR 4.5) and atrial septal defects (SMR 4.9). The largest decreases in SMR occurred for patients with transposition of great arteries (early: 11.0 vs. late: 3.8; p < 0.05), complete atrioventricular canal (31.3 vs. 15.3; p < 0.05), and single ventricle (53.7 vs. 31.3; p < 0.05). Conclusions: In this large U.S. cohort, long-term mortality after congenital heart surgery was elevated across all forms of CHD. Survival has improved over time, particularly for severe defects with significant changes in their management strategy, but still lags behind the general population.

Original languageEnglish (US)
Pages (from-to)2434-2446
Number of pages13
JournalJournal of the American College of Cardiology
Volume71
Issue number21
DOIs
StatePublished - May 29 2018

Fingerprint

Thoracic Surgery
Mortality
Congenital Heart Defects
Survival
Confidence Intervals
Pediatrics
Transposition of Great Vessels
Patent Ductus Arteriosus
Atrial Heart Septal Defects
Survival Analysis
Population
Registries

Keywords

  • children's health
  • congenital heart defects
  • mortality
  • outcomes research

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Research Support, N.I.H., Extramural

Cite this

Spector, L. G., Menk, J. S., Knight, J. H., McCracken, C., Thomas, A. S., Vinocur, J. M., ... Kochilas, L. (2018). Trends in Long-Term Mortality After Congenital Heart Surgery. Journal of the American College of Cardiology, 71(21), 2434-2446. https://doi.org/10.1016/j.jacc.2018.03.491

Trends in Long-Term Mortality After Congenital Heart Surgery. / Spector, Logan G.; Menk, Jeremiah S.; Knight, Jessica H.; McCracken, Courtney; Thomas, Amanda S.; Vinocur, Jeffrey M.; Oster, Matthew E.; St Louis, James D.; Moller, James H.; Kochilas, Lazaros.

In: Journal of the American College of Cardiology, Vol. 71, No. 21, 29.05.2018, p. 2434-2446.

Research output: Contribution to journalArticle

Spector, LG, Menk, JS, Knight, JH, McCracken, C, Thomas, AS, Vinocur, JM, Oster, ME, St Louis, JD, Moller, JH & Kochilas, L 2018, 'Trends in Long-Term Mortality After Congenital Heart Surgery', Journal of the American College of Cardiology, vol. 71, no. 21, pp. 2434-2446. https://doi.org/10.1016/j.jacc.2018.03.491
Spector, Logan G. ; Menk, Jeremiah S. ; Knight, Jessica H. ; McCracken, Courtney ; Thomas, Amanda S. ; Vinocur, Jeffrey M. ; Oster, Matthew E. ; St Louis, James D. ; Moller, James H. ; Kochilas, Lazaros. / Trends in Long-Term Mortality After Congenital Heart Surgery. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 21. pp. 2434-2446.
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AU - Thomas, Amanda S.

AU - Vinocur, Jeffrey M.

AU - Oster, Matthew E.

AU - St Louis, James D.

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N2 - Background: Congenital heart surgery has improved the survival of patients with even the most complex defects, but the long-term survival after these procedures has not been fully described. Objectives: The purpose of this study was to evaluate the long-term survival of patients (age <21 years) who were operated on for congenital heart defects (CHDs). Methods: This study used the Pediatric Cardiac Care Consortium data, a U.S.-based, multicenter registry of pediatric cardiac surgery. Survival analysis included 35,998 patients who survived their first congenital heart surgery at <21 years of age and had adequate identifiers for linkage with the National Death Index through 2014. Survival was compared to that in the general population using standardized mortality ratios (SMRs). Results: After a median follow-up of 18 years (645,806 person-years), 3,191 deaths occurred with an overall SMR of 8.3 (95% confidence interval [CI]: 8.0 to 8.7). The 15-year SMR decreased from 12.7 (95% CI: 11.9 to 13.6) in the early era (1982 to 1992) to 10.0 (95% CI: 9.3 to 10.8) in the late era (1998 to 2003). The SMR remained elevated even for mild forms of CHD such as patent ductus arteriosus (SMR 4.5) and atrial septal defects (SMR 4.9). The largest decreases in SMR occurred for patients with transposition of great arteries (early: 11.0 vs. late: 3.8; p < 0.05), complete atrioventricular canal (31.3 vs. 15.3; p < 0.05), and single ventricle (53.7 vs. 31.3; p < 0.05). Conclusions: In this large U.S. cohort, long-term mortality after congenital heart surgery was elevated across all forms of CHD. Survival has improved over time, particularly for severe defects with significant changes in their management strategy, but still lags behind the general population.

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