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Adult congenital cardiac surgery in Indonesia

Published online by Cambridge University Press:  24 May 2011

Karina V. Wilamarta ,
Yoga Yuniadi ,
Jusuf Rachmat ,
Dicky Fakhri ,
Tarmizi Hakim  and
Maizul Anwar
Karina V. Wilamarta
Affiliation:
Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Yoga Yuniadi*
Affiliation:
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Jusuf Rachmat
Affiliation:
Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Dicky Fakhri
Affiliation:
Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Tarmizi Hakim
Affiliation:
Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
Maizul Anwar
Affiliation:
Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
*
Correspondence to: Yoga Yuniadi, MD, PhD, National Cardiovascular Center Harapan Kita Hospital, Jl. S Parman Kav 87 Slipi, Jakarta 11420, Indonesia. Tel: +62 215684093 ext 1253; Fax: +62 21 536 52358; E-mail: yogayun@yahoo.com
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Abstract

Background

Successful paediatric cardiac surgery and cardiology treatment has resulted in an increase in the use of surgery as a method of treatment of congenital cardiac disease in adult population. However, late detection and lower socio-economic condition in developing countries might change patients’ characteristics by the time they come for treatment. This study aimed to elaborate the long-term surgical results of adult congenital cardiac disease in Indonesia as a developing country.

Methods and results

We reviewed retrospectively all adult congenital cardiac disease patients with a mean age of 28 years plus or minus 9.5 years, who underwent surgery at National Cardiovascular Center. The types of procedures used were corrective in 338 patients (89.2%), palliative in 10 patients (2.6%), and re-operations in 31 patients (8.2%). The overall hospital mortality rate was 2.6% but as high as 20% with palliative surgery. Post-operative New York Heart Association class III–IV is the only independent predictor of death at 60 months (hazard ratio 61.48, 95% confidence interval 9.41–401.69, p<0.001). The survival rates were 96.3% and 95% for overall and non-atrial septal defect in patients at 60 months, which was highest in corrective procedures (97.6%). The percentage of patients free of re-operation at 5 years’ follow-up was 85.4% and 42.7% at 10 years.

Conclusion

In developing countries, surgical treatment of adult congenital cardiac disease is effective and safe, with an overall survival rate of 96.3% at 60 months. Due to high mortality rate, palliative surgery of a non-atrial septal defect patient is recommended to be discontinued. The independent predictor of mortality was post-operative New York Heart Association functional class III–IV.

Keywords

Grown-up congenital heartlong-term surgical resultsdeveloping country
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 6 , 28 October 2011 , pp. 639 - 645
Copyright
Copyright © Cambridge University Press 2011

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Footnotes

a

Drs K.V. Wilamarta and Y. Yuniadi, had an equal contribution in this study.

References

1.Borghi, A, Ciuffreda, M, Quattrociocchi, M, Preda, L. The grown-up congenital cardiac patient. J Cardiovasc Med 2007; 8: 78–82.CrossRefGoogle ScholarPubMed
2.Deanfield, J, Thaulow, E, Warnes, C, et al. Management of grown up congenital heart disease. Eur Heart J 2003; 24: 1035–1084.CrossRefGoogle ScholarPubMed
3.Sommerville, J. Management of adults with congenital heart disease: an increasing problem. Annu Rev Med 1997; 48: 283–293.CrossRefGoogle Scholar
4.Gatzoulis, MA. Adult congenital heart disease: education, education, education. Nat Clin Pract Cardiovasc Med 2006; 3: 2–3.CrossRefGoogle ScholarPubMed
5.de Groot, NM, Natasja, MS, Schalij, MJ. Euro Heart Survey on adult congenital heart disease: concern for the complexity of care. Eur Heart J 2006; 27: 1268–1269.CrossRefGoogle ScholarPubMed
6.Reid, GJ, Irvine, MJ, McCrindle, BW, et al. Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects. Pediatrics 2004; 113: e197–e205.CrossRefGoogle ScholarPubMed
7.Kaemmerer, A, Meijboom, FJ, Oechslin, E, Mulder, BJM. On behalf of the Expert Committee of Euro heart survey on adult congenital heart disease. Delivery of care for adult patients with congenital heart disease in Europe: results from the Euro heart survey European. Heart 2006; 27: 1324–1330.Google Scholar
8.Jacobs, JP, Lacour-Gayet, F, Jacobs, ML, et al. Initial application in the STS congenital database of complexity-adjustment to evaluate surgical case mix and results. Ann Thorac Surg 2005; 79: 1635–1649.CrossRefGoogle ScholarPubMed
9.Somerville, J. British Cardiac Society Report of the British Cardiac Society Working Party. Grown-up congenital heart (GUCH) disease: current needs and provision of service for adolescents and adults with congenital heart disease in the UK. Heart 2002; 88 suppl. 1: 1–14.Google Scholar
10.Ashburn, DA, Williams, WG, Van arsdell, GS. Adult congenital cardiac surgery. In: Sabiston & Spencer Surgery of the Chest, 7th edn. Elsevier Saunders, Philadelphia, 2005, pp 2233–2253.Google Scholar
11.Srinathan, SK, Bonser, RS, Sethia, B, Thorne, SA, Brawn, WJ, Barron, DJ. Changing practice of cardiac surgery in adult patients with congenital heart disease. Heart 2005; 91: 139–140.CrossRefGoogle ScholarPubMed
12.Kouchoukos, NT, Blackstone, EH, Doty, DB, Hanley, FL, Karp, RB. Atrial Septal Defect and Partial Anomalous Pulmonary Venous Connection. In: Kirklin/Barratt-Boyes Cardiac Surgery Vol. 1. 3rd edn. Churchill Livingstone, Philadelphia, 2003, pp 726–743.Google Scholar
13.Vida, VL, Berggren, H, Brawn, WJ, et al. Risk of surgery for congenital heart disease in the adult: a multicentered European study. Ann Thorac Surg 2007; 83: 161–168.CrossRefGoogle ScholarPubMed
14.Rossano, JW, Smith, BEO, Fraser, CD, et al. Adults undergoing cardiac surgery at children's hospital: an analysis of perioperative morbidity. Ann Thorac Surg 2007; 83: 606–612.CrossRefGoogle ScholarPubMed
15.Williams, WG, Ashburn, DA, Downar, EH. Cardiac reoperations in adults with congenital cardiac surgery. In: Franco KL, Verrier ED (eds.). Advanced Therapy in Cardiac Surgery. BC Decker, London, 2003, pp 263–268.Google Scholar