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Gullo G, Scaglione M, Laganà AS, Perino A, Andrisani A, Chiantera V, Cucinella G, Gitas G, Barra F, Riemma G. Assisted Reproductive Techniques and Risk of Congenital Heart Diseases in Children: a Systematic Review and Meta-analysis. Reprod Sci 2023; 30:2896-2906. [PMID: 37145300 PMCID: PMC10556115 DOI: 10.1007/s43032-023-01252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
Infertility is a growing phenomenon and leads to an increased use of assisted reproductive techniques (ARTs). In recent years, concerns about the safety of these procedures emerged and ARTs were hypothesized to be a risk factor for developing congenital heart diseases (CHDs) in offspring. Our aim is to investigate the association between ART and CHD, specifying results according to various subtypes of defects. We performed a systematic review and random-effects meta-analysis following the PRISMA guidelines. MEDLINE and Google Scholar were searched from January 2011 to May 2022. Data about incidence of CHD in ART were tabulated and extracted from all the studies included. Twenty-four studies were included. Pooled incidence of CHDs after IVF pregnancies was 3% (95% CI 0.3-0.4; I2 = 99%), decreasing to 1% (95% CI 0.00-0.01; I2 = 93%) for major CHDs only. An increased risk of CHDs, especially minor (i.e., not requiring surgical correction), seems to occur in ART compared with non-ART pregnancies [RR 1.71 (95% CI 1.25-2.34; I2 = 99%)]. For major CHDs, not enough evidence is available to assess the real risk. Moreover, some confounding factors (i.e., maternal age and male infertility) seem to play a critical role to determine an increased risk of CHDs. Conflicting results emerged among the studies, setting the need for further research to validate the actual evidence and state the real risk of CHD following ART pregnancies.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Marco Scaglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Genoa, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli," Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Perino
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Alessandra Andrisani
- Department of Women's and Children's Health, Gynaecologic and Obstetrics Clinic, University of Padua, Padua, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli," Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, Palermo, Italy
| | - Georgios Gitas
- Department of Gynecology, University Hospital Charite, Campus Mitte, Berlin, Germany
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy.
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Geoffrion T, Fuller S. Surgery for Adult Congenital Heart Disease. Cardiol Clin 2020; 38:435-443. [PMID: 32622495 DOI: 10.1016/j.ccl.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Technical and medical improvements for congenital cardiac disease in children have contributed to an increasing population of patients who survive into adulthood. These patients may be prone to progression of their native palliated disease or suffer from sequelae of their childhood repair that requires repeat surgical intervention. Surgery for adult congenital cardiac disease poses unique challenges and risks.
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Affiliation(s)
- Tracy Geoffrion
- The Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Stephanie Fuller
- The Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Caughron H, Kim D, Kamioka N, Lerakis S, Yousef A, Maini A, Reginauld S, Sahu A, Shashidharan S, Jokhadar M, Rodriguez FH, Book WM, McConnell M, Block PC, Babaliaros V. Repeat Pulmonary Valve Replacement: Similar Intermediate-Term Outcomes With Surgical and Transcatheter Procedures. JACC Cardiovasc Interv 2018; 11:2495-2503. [PMID: 30503596 DOI: 10.1016/j.jcin.2018.07.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study compares 30-day, 1-year, and 3-year echocardiographic findings and clinical outcomes of transcatheter pulmonary valve-in-valve replacement (TPVR) and repeat surgical pulmonary valve replacement (SPVR). BACKGROUND In patients with adult congenital heart disease and previous pulmonary valve replacement (PVR) who require redo PVR, it is unclear whether TPVR or repeat SPVR is the preferred strategy. METHODS We retrospectively identified 66 patients (TPVR, n = 36; SPVR, n = 30) with bioprosthetic pulmonary valves (PVs) who underwent either TPVR or repeat SPVR at Emory Healthcare from January 2007 to August 2017. RESULTS The TPVR cohort had fewer men and more patients with baseline New York Heart Association (NYHA) functional class III or IV. There was no difference in mortality, cardiovascular readmission, or post-procedural PV reintervention at 30 days, 1 year, or 3 years. Post-procedural echocardiographic findings showed no difference in mean PV gradients between the TPVR and SPVR groups at 30 days, 1 year, or 3 years. In the TPVR cohort, there was less right ventricular dysfunction at 30 days (2.9% vs. 46.7%; p < 0.01), despite higher baseline NYHA functional class in the SPVR cohort. CONCLUSIONS In patients with bioprosthetic PV dysfunction who underwent either TPVR or SPVR, there was no difference in mortality, cardiovascular readmission, or repeat PV intervention at 30 days, 1 year, or 3 years. Additionally, TPVR and SPVR had similar intermediate-term PV longevity, with no difference in PV gradients or PVR. The TPVR cohort also had less right ventricular dysfunction at 30 days despite a higher baseline NYHA functional classification. These intermediate-term results suggest that TPVR may be an attractive alternative to SPVR in patients with previous bioprosthetic surgical PVs.
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Affiliation(s)
- Hope Caughron
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Dennis Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Altayyeb Yousef
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Shawn Reginauld
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anurag Sahu
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Subhadra Shashidharan
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maan Jokhadar
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Wendy M Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael McConnell
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
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Kratzert WB, Boyd EK, Schwarzenberger JC. Management of the Critically Ill Adult With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2017; 32:1682-1700. [PMID: 29500124 DOI: 10.1053/j.jvca.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 02/01/2023]
Abstract
Survival of adults with congenital heart disease (CHD) has improved significantly over the last 2 decades, leading to an increase in hospital and intensive care unit (ICU) admissions of these patients. Whereas most of the ICU admissions in the past were related to perioperative management, the incidence of medical emergencies from long-term sequelae of palliative or corrective surgical treatment of these patients is rising. Intensivists now are confronted with patients who not only have complex anatomy after congenital cardiac surgery, but also complex pathophysiology due to decades of living with abnormal cardiac anatomy and diseases of advanced age. Comorbidities affect all organ systems, including cognitive function, pulmonary and cardiovascular systems, liver, and kidneys. Critical care management requires an in-depth understanding of underlying anatomy and pathophysiology in order to apply contemporary concepts of adult ICU care to this population and optimize patient outcomes. In this review, the main CHD lesions and their common surgical management approaches are described, and the sequelae of CHD physiology are discussed. In addition, the effects of chronic comorbidities on the management of critically ill adults are explored, and the adjustments of current ICU management modalities and pharmacology to optimize care are discussed.
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Affiliation(s)
- Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA.
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
| | - Johanna C Schwarzenberger
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
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Matsuo K, Kabasawa M, Asano S, Tateno S, Kawasoe Y, Okajima Y, Hayashida N, Murayama H. Surgical treatment for adult congenital heart disease: consideration for indications and procedures. Gen Thorac Cardiovasc Surg 2017; 66:57-64. [PMID: 29119450 DOI: 10.1007/s11748-017-0861-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/28/2017] [Indexed: 11/29/2022]
Abstract
The number of the adult patients with congenital heart diseases (ACHD) continues to grow owing to improvement of surgical results and medical management. Corrective surgery for complex CHD does not always mean complete cure. It is not rare that the patients will visit the cardiology institutes because of secondary lesions due to residua or sequela in adults. Some patients with CHD remain unrepairable with different degree of heart failure and pulmonary arterial hypertension. Association of arrhythmias is common in ACHD patients and sometimes critical. We experienced 265 surgical procedures for ACHD patients at our center between 1999 and 2015. Of these procedures, palliative surgery was performed in 3%, palliation to corrective surgery in 6%, primary repair in 57%, and redo surgery in 34%. Hospital mortality within 30 days in this period was 1.1%. Surgery for ACHD patients is safe, beneficial and low-risk treatment; however, tailored procedures for the individual patient are essential to obtain the optimal quality. A comprehensive multidisciplinary approach is required to fulfill this goal.
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Affiliation(s)
- Kozo Matsuo
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan.
| | - Masashi Kabasawa
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Soichi Asano
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Shigeru Tateno
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Yasutaka Kawasoe
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Yoshitomo Okajima
- Section of Adult Congenital Heart Disease, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Naoki Hayashida
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
| | - Hirokazu Murayama
- Department of Cardiovascular Surgery, Chiba Cerebral and Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba, 290-0512, Japan
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Stulak JM, Mora BN, Said SM, Schaff HV, Dearani JA. Mechanical Pulmonary Valve Replacement. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 19:82-9. [PMID: 27060049 DOI: 10.1053/j.pcsu.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/04/2015] [Accepted: 12/06/2015] [Indexed: 11/11/2022]
Abstract
Although most valve operations performed annually address lesions of the aortic or mitral valves, the frequency of pulmonary valve replacement (PVR) is increasing because most patients with congenital heart disease are surviving into the adult years. The vast majority of patients, especially children that require PVR, obtain a tissue valve because of the relative good durability and the lack of a need for anticoagulation. Because the need for repeat operation is inevitable for most patients, and the population of adults with congenital heart disease continues to grow, there are increasing situations in which a mechanical pulmonary prosthesis may be appropriate. Most patients being considered for mechanical PVR have a congenital diagnosis and require multi-valve procedures, and quality of life and need for repeat operation(s) are major issues. Mechanical valves are durable but require anticoagulation, which carries its own inherent set of risks. There are conflicting reports regarding the late outcome of mechanical PVR. There are few reports that indicate that, in the pulmonary position, bileaflet valves are at higher risk for complications compared with monodisc valves; however, the majority of these patients were not anticoagulated with warfarin, but simply maintained on aspirin. There is a growing body of literature documenting low rates of thrombosis or pulmonary prosthesis dysfunction when proper anticoagulation and monitoring are applied.
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Affiliation(s)
- John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN
| | - Bassem N Mora
- Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN.
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Weis RA, Devaleria PA, Koushik S, Ramakrishna H. The increasing importance of percutaneous mechanical circulatory assist device therapy in heart failure management. Ann Card Anaesth 2015; 18:467-73. [PMID: 26440230 PMCID: PMC4881681 DOI: 10.4103/0971-9784.166441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Advances in medical and surgical care have made it possible for an increasing number of patients with Congenital Heart disease (CHD) to live into adulthood. Transposition of the great vessels (TGV) is the most common cyanotic congenital cardiac disease where the right ventricle serves as systemic ventricle. It is not uncommon for these patients to have systemic ventricular failure requiring transplantation. Study Design: Hemodynamic decompensation in these patients can be swift and difficult to manage. Increasingly percutaneous LVAD's such as the Impella (Abiomed, Mass, USA) are gaining popularity in these situations owing to their relative ease of placement, both in and outside of the operating room. Conclusion: In this paper we demonstrate that Impella (IMP) CP placement through the axillary artery approach shows to be suitable option for short term cardiac support and improvement of end organ perfusion in anticipation of cardiac transplantation.
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Affiliation(s)
| | | | | | - Harish Ramakrishna
- Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Said SM, Driscoll DJ, Dearani JA. Transition of care in congenital heart disease from pediatrics to adulthood. Semin Pediatr Surg 2015; 24:69-72. [PMID: 25770366 DOI: 10.1053/j.sempedsurg.2015.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improvement in surgical techniques, anesthesia, and perioperative care has resulted in the majority of children born with congenital heart defects surviving into adulthood with a normal or near-normal quality of life. A careful transition from pediatric to adult care providers is important to avoid issues related to loss of continuity of care and any undue financial or psychological burdens to the patients and their families. The patients, their families, and the health care providers are faced with many challenges during this transition process that can be optimized and overcome by education about the heart defects and a team approach with clear lines of communication. This review addresses the challenges related to the transition of care from pediatrics to adults and provides the necessary recommendations to ensure a smooth transition process.
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Affiliation(s)
- Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | | | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Affiliation(s)
- Elizabeth B. Rand
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
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Reoperative Multivalve Surgery in Adult Congenital Heart Disease. Ann Thorac Surg 2013; 95:1383-9. [DOI: 10.1016/j.athoracsur.2012.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 11/30/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022]
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Kogon B, Grudziak J, Sahu A, Jokhadar M, McConnell M, Book W, Oster M. Surgery in adults with congenital heart disease: risk factors for morbidity and mortality. Ann Thorac Surg 2013; 95:1377-82; discussion 1382. [PMID: 23462261 DOI: 10.1016/j.athoracsur.2012.11.076] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/11/2012] [Accepted: 11/19/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with congenital heart disease are frequently surviving into adulthood, and many of them will require surgery. Unfortunately, outcome data in this patient population are limited. We aimed to identify risk factors associated with adverse events in adults with congenital heart disease undergoing cardiac surgery and establish long-term survival data. METHODS We retrospectively studied 458 adult patients who underwent cardiac surgery for congenital heart disease between 2000 and 2010. We constructed logistic models to assess risk factors for mortality, major adverse event (stroke, renal failure, prolonged ventilation, prolonged coma, deep sternal infection, reoperation, and operative mortality), and prolonged length of stay (>7 days). Long-term, all-cause mortality was also measured. RESULTS Sixteen patients died (3.49%). Risk factors for mortality included a history of cerebrovascular disease (odds ratio [OR]: 4.51), New York Heart Association (NYHA) class 3 or 4 (OR: 8.88), and surgery on the aorta or the aortic valve (OR: 5.74). Ninety-four patients suffered a major adverse event (20.5%). Significant risk factors were male gender (OR: 2.28), NYHA class of 3 or 4 (OR 2.58), 2 concomitant major operations (OR: 2.15), and cardiopulmonary bypass time of greater than 100 minutes (OR: 3.18). Last, 90 patients (19.7%) remained in the hospital longer than 7 days. Significant risk factors for a prolonged length of stay included chronic lung disease (OR: 3.05), NYHA class of 3 or 4 (OR: 3.69), surgery by an adult cardiac surgeon (OR 2.58), 2 concomitant major operations (OR: 3.28), and cardiopulmonary bypass time of greater than 100 minutes (OR: 2.41). Survival at 1, 5, and 10 years was 97.6%, 95.2%, and 93.4%, respectively. CONCLUSIONS Surgery in adults with congenital heart disease can be performed with low morbidity and mortality. Nonetheless, there remain important risk factors for adverse events. Awareness and modification of risk factors may help improve outcomes.
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Affiliation(s)
- Brian Kogon
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Stulak JM, Dearani JA, Burkhart HM, Connolly HM, Warnes CA, Suri RM, Schaff HV. The Increasing Use of Mechanical Pulmonary Valve Replacement Over a 40-Year Period. Ann Thorac Surg 2010; 90:2009-14; discussion 2014-5. [DOI: 10.1016/j.athoracsur.2010.07.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 07/04/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
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15
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Gadhinglajkar SV, Sreedhar R, Chandranmahaldar DA, Minhaj MM, Tempe DK. Case 2-2010 combined surgery for coronary artery disease, mitral stenosis, and double-chamber right ventricle. J Cardiothorac Vasc Anesth 2010; 24:356-63. [PMID: 20362239 DOI: 10.1053/j.jvca.2010.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Indexed: 11/11/2022]
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