Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort
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 h...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1568920/full |
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| author | Matthanja Bieze Oliver Poole Arshia Delfani Jane Heggie Jane Heggie Marcus Salvatori |
| author_facet | Matthanja Bieze Oliver Poole Arshia Delfani Jane Heggie Jane Heggie Marcus Salvatori |
| author_sort | Matthanja Bieze |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-9d2491dca2ce452b8a3ef9feeed819b9 |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-9d2491dca2ce452b8a3ef9feeed819b92025-08-20T02:57:48ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-06-011210.3389/fcvm.2025.15689201568920Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohortMatthanja Bieze0Oliver Poole1Arshia Delfani2Jane Heggie3Jane Heggie4Marcus Salvatori5Department of Anesthesia and Pain Management, Toronto General Hospital and Department of Anesthesiology, and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Anesthesia and Pain Management, QEII Health Sciences Center, Halifax, NS, CanadaDepartment of Anesthesia and Pain Management, Toronto General Hospital and Department of Anesthesiology, and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Anesthesia and Pain Management, Toronto General Hospital and Department of Anesthesiology, and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Cardiac Critical Care, Toronto General Hospital and Department of Anesthesiology, and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Anesthesia and Pain Management, Toronto General Hospital and Department of Anesthesiology, and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaIntroductionThe 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.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1568920/fulladult congenital heart diseaseperioperative riskpostoperative complicationsover 50cardiac surgeryaging |
| spellingShingle | Matthanja Bieze Oliver Poole Arshia Delfani Jane Heggie Jane Heggie Marcus Salvatori Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort Frontiers in Cardiovascular Medicine adult congenital heart disease perioperative risk postoperative complications over 50 cardiac surgery aging |
| title | Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort |
| title_full | Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort |
| title_fullStr | Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort |
| title_full_unstemmed | Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort |
| title_short | Characteristics and risk profile of the over fifty adult congenital heart surgical population, a retrospective cohort |
| title_sort | characteristics and risk profile of the over fifty adult congenital heart surgical population a retrospective cohort |
| topic | adult congenital heart disease perioperative risk postoperative complications over 50 cardiac surgery aging |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1568920/full |
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