TY - JOUR

T1 - Survival and morbidity following congenital heart surgery in a population-based cohort of children--up to 12 years of follow-up

AU - Larsen, Signe Holm

AU - Emmertsen, Kristian

AU - Johnsen, Søren Paaske

AU - Pedersen, Jens

AU - Hjortholm, Kirsten

AU - Hjortdal, Vibeke Elisabeth

N1 - © 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

PY - 2011/3/23

Y1 - 2011/3/23

N2 - OBJECTIVES: The Risk Adjusted Classification for Congenital Heart Surgery can predict early mortality. However, the relation to long-term outcome in terms of mortality and morbidity is unknown.DESIGN: We did a population-based follow-up study of 801 children undergoing congenital heart surgery between 1996 and 2002. All patients were followed from surgery until death or January 1, 2008. Operations were classified according to the Risk Adjusted Classification for Congenital Heart Surgery. Each patient was matched by age and sex with 10 population controls. Cox regression analysis, area under the receiver operator curve and competing risk analysis were used for the analyses.RESULTS: Overall follow-up was 99.6%. The distribution of the Risk Adjusted Classification for Congenital Heart Surgery was: Category one 20%, category two 37%, category three 27%, category four 8%, category five 0% and category six 2%. Overall survival after a median follow-up of 8.2 years was 86% (95% confidence interval: 83-88%), with 54 early deaths occurring within 30 days after surgery and 57 late deaths. Long-term survival in those who were alive 30 days after surgery was 92% (90-94%); ranging from 98% (93-100%) in risk category one to 33% (5-68%) in category six. Survival overall and beyond 30 days was lower in each risk category than in controls (P < .001). During follow-up, 124 (15%) patients had new operations and 106 (13%) catheter-based interventions. These events were more frequent in category three, four, and six compared with category one, with no difference between category one and two. The area under the receiver operator curve for long-term mortality was 0.81 (95% confidence interval 0.75-0.87).CONCLUSIONS: Children operated for congenital heart disease have impaired survival and often undergo new operations or catheter-based interventions. The risk of these events is related to the surgical complexity according to the Risk Adjusted Classification for Congenital Heart Surgery.

AB - OBJECTIVES: The Risk Adjusted Classification for Congenital Heart Surgery can predict early mortality. However, the relation to long-term outcome in terms of mortality and morbidity is unknown.DESIGN: We did a population-based follow-up study of 801 children undergoing congenital heart surgery between 1996 and 2002. All patients were followed from surgery until death or January 1, 2008. Operations were classified according to the Risk Adjusted Classification for Congenital Heart Surgery. Each patient was matched by age and sex with 10 population controls. Cox regression analysis, area under the receiver operator curve and competing risk analysis were used for the analyses.RESULTS: Overall follow-up was 99.6%. The distribution of the Risk Adjusted Classification for Congenital Heart Surgery was: Category one 20%, category two 37%, category three 27%, category four 8%, category five 0% and category six 2%. Overall survival after a median follow-up of 8.2 years was 86% (95% confidence interval: 83-88%), with 54 early deaths occurring within 30 days after surgery and 57 late deaths. Long-term survival in those who were alive 30 days after surgery was 92% (90-94%); ranging from 98% (93-100%) in risk category one to 33% (5-68%) in category six. Survival overall and beyond 30 days was lower in each risk category than in controls (P < .001). During follow-up, 124 (15%) patients had new operations and 106 (13%) catheter-based interventions. These events were more frequent in category three, four, and six compared with category one, with no difference between category one and two. The area under the receiver operator curve for long-term mortality was 0.81 (95% confidence interval 0.75-0.87).CONCLUSIONS: Children operated for congenital heart disease have impaired survival and often undergo new operations or catheter-based interventions. The risk of these events is related to the surgical complexity according to the Risk Adjusted Classification for Congenital Heart Surgery.

KW - Adolescent

KW - Cardiac Catheterization

KW - Cardiac Surgical Procedures/adverse effects

KW - Case-Control Studies

KW - Child

KW - Child, Preschool

KW - Denmark/epidemiology

KW - Disease-Free Survival

KW - Female

KW - Heart Defects, Congenital/mortality

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Kaplan-Meier Estimate

KW - Male

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Reoperation

KW - Risk Assessment

KW - Risk Factors

KW - Survival Rate

KW - Survivors/statistics & numerical data

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1111/j.1747-0803.2011.00495.x

DO - 10.1111/j.1747-0803.2011.00495.x

M3 - Journal article

C2 - 21418533

VL - 6

SP - 322

EP - 329

JO - Congenital Heart Disease

JF - Congenital Heart Disease

SN - 1747-079X

IS - 4

ER -