ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1568920
This article is part of the Research TopicSurgical and Non-Surgical Intervention of Congenital Heart Disease Management in Developing and Developed CountriesView all 13 articles
Characteristics and Risk Profile of the over Fifty Adult Congenital Heart Surgical Population, a Retrospective Cohort
Provisionally accepted
- 1Department of Anesthesiology and Pain Management, University Health Network (UHN), Toronto, Canada
- 2Department of Anesthesiology and Pain Management, Heart Hospital, Halifax, Canada
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IntroductionThe surgical and medical management of aging patients with adult congenital heart disease (ACHD) continues to innovate to meet the evolving needs of this unique patient population, leading to improved life expectancy and quality of life. However, the ACHD population is characterized by high morbidity and mortality. With this study, we aim to describe patient characteristics and surgical outcomes for the over fifty ACHD cardiac surgical cohort, focusing on risk factors for mortality and major complications. MethodsThis was a retrospective cohort study including ACHD patients undergoing surgical repair from January 2004 to March 2023. Primary outcome was the composite of severe postoperative complications and secondary outcomes were 1-year mortality, ICU stay and hospital length of stay. Descriptive statistics, univariable and multivariable logistic regression models were used. ResultsIn the study period, 1381 patients with ACHD underwent cardiac surgery, of which 292 (20.5%) were over 50 years. In the overall group, the most common primary surgery was pulmonary valve replacement in 411 (29.8%), in the over 50 group this was ASD and VSD repairs in 102 (34.9%). The composite of major postoperative complications was different between the overall group and the over 50 years group (10.7% vs 13.7%; P=0.049), which in the over 50 group was associated with CPB time (180 min vs 104 min, OR 1.01; 95%CI 1.00-1.03), and preoperative creatinine levels (84 vs 77, OR 1.01; 95%CI 1.00-1.03). No difference was seen in 1-year mortality (P=0.415). ConclusionWith careful patient selection and preoperative optimization, surgical risks remain low, even in aging ACHD patients. Although overall mortality rates are low, postoperative complications increase, and patients over 50 with DM, renal failure, long pump runs or postoperative stroke are at highest risk.
Keywords: Adult congenital heart disease, Perioperative risk, Postoperative Complications, over 50, cardiac surgery
Received: 30 Jan 2025; Accepted: 07 May 2025.
Copyright: © 2025 Bieze, Poole, Delfani, Heggie and Salvatori. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Matthanja Bieze, Department of Anesthesiology and Pain Management, University Health Network (UHN), Toronto, Canada
Marcus Salvatori, Department of Anesthesiology and Pain Management, University Health Network (UHN), Toronto, Canada
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