Congenital Heart Surgery in Youth Increases Risk of CV, Non-CV Complications
JUNE 30, 2020
Alireza Raissadata, MD, PhD
Results of the study, which assessed data from more than 8k patients who underwent congenital heart surgery and matched cohorts, found a slew of long-term cardiovascular and noncardiovascular complications were more common among patients who underwent congenital heart surgery during childhood than their healthy counterparts.
"The findings emphasize the importance of long-term follow-up among this patient group. Furthermore, the study highlights the extensive coverage of Finland's national databases and the excellent opportunities for follow-up studies they provide, not available in many other countries," said study investigator Alireza Raissadati, MD, PhD, a pediatrician specializing in pediatric cardiology at New Children’s Hospital of the University of Helsinki, in a statement.
While postoperative morbidity remains a paramount concern for patients with congenital heart defects, advances in care have allowed more patients to survive later into adulthood. To further understand the risks of comorbidities in this population, investigators designed their study using data from patients from Finland aged 15 years and under who underwent congenital heart surgery from 1966 to 2009.
For their analysis, investigators identified patient data Research Registry of Pediatric Cardiac Surgery, which included data from 5 university hospitals across Finland beginning in 1953. Investigators pointed out the later starting point chosen for the study was based on the introduction of a medical reimbursement program in Finland.
Using the Finnish Population Registry, investigators were able to create 4 age-, sex-, birth date-, and hospital district-matched control subjects per patient. The Finnish Population Registry was also used to identify patient status and time of death for controls and patients with congenital heart defects.
In total, 8631 patients with congenital heart disease were identified for inclusion in the study, of which 99.9% (n=8623) had complete follow-up data. Of these patients, 5604 were classified as having a simple defect, 1440 as having a severe defect, and 1579 as miscellaneous defects. Simple defects included patent ductus arteriosus (PDA), atrial septal defects (ASD), coarctation of the aorta (COA), and ventricular septal defect (VSD). Severe defects included tetralogy of Fallot (TOF), univentricular heart defect (UHD), hypoplastic heart syndrome (HLHS), and transposition of the great arteries (TGA).
Upon analysis, 43% (n=3750) of patients who underwent congenital heart surgery required special reimbursements. The most common comorbidity among these patients was cardiovascular disease, which was present in 28% of patients. Other common comorbidity included obstructive pulmonary disease (9%), neurologic disease (3%), and psychiatric disease (2%).
Overall, patients who underwent congenital heart surgery had an 11.5-times greater risk of developing cardiovascular disease (RR, 11.5; 95% CI, 10.5–12.7), 1.8-times greater risk of developing obstructive pulmonary disease (RR, 1.8; 95% CI, 1.6–1.9), a 2-times greater risk of endocrine disease (RR, 1.8; 95% CI, 1.6–1.9), a 2.5-times greater risk of neurologic disease (RR, 2.5; 95% CI, 2.1–2.9), and a 1.3-times greater risk of psychiatric disease (RR, 1.3; 95% CI, 1.1–1.6) versus controls. Investigators highlighted chronic diseases were usually more prevalent in patients with severe compared to simple defects.
This study, “Chronic Disease Burden After Congenital Heart Surgery: A 47‐Year Population‐Based Study With 99% Follow‐Up,” was published in the Journal of the American Heart Association.