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CLINICAL RESEARCH: SURGERY FOR CONGENITAL HEART DISEASE

Causes of Late Deaths After Pediatric Cardiac Surgery

A Population-Based Study

Heta P. Nieminen, MD^_*,_*, Eero V. Jokinen, MD and Heikki I. Sairanen, MD^_*

^_* Surgery
Cardiology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

Manuscript received December 12, 2006; revised manuscript received April 27, 2007, accepted May 22, 2007.

^_* Reprint requests and correspondence: Dr. Heta Nieminen, Piippukalliontie 33, 36270 Kangasala, Finland. (Email: heta.nieminen{at}elisanet.fi).

Objectives: We examined the causes and modes of late death after pediatric cardiac surgery.

Background: The late mortality of patients operated on for congenital heart defect (CHD) is comprehensively unexamined. In this study, the causes of death were examined to obtain further knowledge of the morbidity of the patients.

Methods: We studied all late deaths of patients operated on for CHD in Finland during the years 1953 to 1989. We calculated the survival of patients, identified the causes of deaths from death certificates, and examined the modes of CHD-related deaths. We compared the survival and the causes of non–CHD-related deaths to those of the general population.

Results: Of the 6,024 patients who survived their first operation, 592 (9%) died during the 45-year follow-up period. The progress of treatment was seen in the survival of the patients operated on in different decades. The cause of death was confirmed with postmortem examination in 474 (81%) cases. The majority of patients (397, 67%) died owing to the CHD. Furthermore, non–CHD-related mortality was twice as high (risk ratio 1.9, 95% confidence interval 1.5 to 2.4) as expected. The main mode for CHD-related death was heart failure (40%). Other modes included perioperative (26%), sudden (22%), and cardiovascular (12%) deaths. The number of deaths caused by neurological and respiratory diseases was higher and the number of accidental deaths was lower than expected.

Conclusions: The survival of patients was lower than that of the general population (relative 45-year survival 89%). Most patients died owing to CHDs, but non–CHD-related mortality was also high.

Abbreviations and Acronyms   ASD = atrial septal defect   CHD = congenital heart defect   CI = confidence interval   CoA = coarctation of aorta   PDA = patent ductus arteriosus   PS = pulmonary stenosis   RR = relative risk   SMR = standardized mortality ratio   TGA = transposition of the great arteries   TOF = tetralogy of Fallot   UVH = univentricular heart   VSD = ventricular septal defect

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