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by
Ad J.J.C. Bogers |
Total Records (
2 ) for
Ad J.J.C. Bogers |
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Leon M. Putman
,
Menno van Gameren
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Folkert J. Meijboom
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Peter L. de Jong
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Jolien W. Roos-Hesselink
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Maarten Witsenburg
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Johanna J.M. Takkenberg
and
Ad J.J.C. Bogers
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Objective: With a growing number of children with congenital heart disease (CHD) reaching adulthood, an extensive experience with cardiac surgery in adults with CHD is accumulating. To increase insight in this patient category we report our 17-year single centre experience including predictors for adverse outcome and EuroSCORE performance. Methods: Patients and operative characteristics of all consecutive adult CHD patients operated upon between January 1990 and January 2007 were collected. Categorisation was done according to the EACTS/STS congenital database. Early and late morbidity and mortality were assessed with follow-up extending up to 17 years. EuroSCORE performance was assessed. Results: Nine hundred and sixty-three procedures were performed in 830 patients (mean age 39.3 years, 50.3% male). A total of 49% were re-do procedures, frequent procedures were for left heart lesions (37%), right heart lesions (31%) and septal defects (8%). The 51% primary procedures largely consisted of less complex procedures but also included 1.4% of tetralogy of Fallot repairs, 4.1% of aortic coarctation repairs and 2.7% of Ebstein's disease repairs. Thirty-day mortality was 1.5% (n = 14); predicted mortality by logistic EuroSCORE was 4.6%. c-index was 0.61 (95% CI 0.46–0.75). Major complications such as tamponade requiring intervention occurred in 3.2%, postoperative bleeding requiring re-exploration in 7.1% and renal insufficiency requiring dialysis in 4 (0.4%). Pulmonary hypertension was a b predictor for short-term mortality; impaired ventricular function and cyanosis for long-term mortality. Overall 17-year survival was 71% (95% CI 61%–82%). Eighty percent of patients were in NYHA class I at last follow-up, 17% in II, 3% in III, 0% in IV. Conclusions: Surgery in adult CHD patients can be performed with low operative mortality and good clinical outcome. EuroSCORE is not a good model for risk assessment in this group of patients. |
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Jos A. Bekkers
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Loes M.A. Klieverik
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Goris Bol Raap
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Johanna J.M. Takkenberg
and
Ad J.J.C. Bogers
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Reoperative Aortic Root Replacement (RARR) is a complex and high-risk operation. We studied outcome of patients who underwent RARR after previous surgery on aortic valve, aortic root or ascending aorta. Between 1981 and 2006, 141 consecutive patients underwent 156 RARRs at the institution. Patient and peri-operative characteristics, short and long-term outcome were analyzed. Mean age was 37 years (0.3-76 years). RARR was performed on 56 prosthetic valves, 23 allografts, 28 pulmonary autografts and 49 native valves. RARR indications were: structural failure 47% (n = 72), neo-aortic root dilatation 18% (n = 28), aneurysm/dissection 13% (n = 21), endocarditis 15% (n = 24), non-structural failure 6% (n = 10) and valve thrombosis 1% (n = 1). About 36% (n = 56) received an allograft, 34% (n = 54) an aortic valve conduit (Bentall) and 30% (n = 46) a pulmonary autograft. Hospital mortality was 9% (n = 14): 14% (n = 8) prosthetic valve patients, 13% (n = 3) allograft patients, 6% (n = 3) native valve patients and 0% autograft patients died. Potential hospital mortality predictors were longer perfusion and cross clamp time, older patient age, female gender, unplanned CABG, concomitant mitral valve replacement and emergency surgery. During follow-up (mean 6.5 years, range 0-18 years), 13 patients died (LOR 1.3%/patient year); 8 prosthetic valves patients, 1 allograft patient, 3 native valve patients and 1 autograft patient. Overall 10 years survival was 78±4%; for prosthetic valve patients 65±8%, for allograft patients 82±8%, for native valve patients 87±5% and for autograft patients 96±4%. RARR can be safely performed. Especially, pulmonary autograft reoperation has low hospital mortality and morbidity rates with excellent survival. In this respect, these results may contribute to decision making in valve substitute selection in primary aortic valve replacement, especially in adolescents and young adults. |
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