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Cardiac surgery in adults with high-surgical complexity CHD: results of a network collaborative programme

Published online by Cambridge University Press:  29 August 2017

Vered Gilad Open the ORCID record for Vered Gilad [Opens in a new window] ,
Francesco Santoro ,
Elena Ribera ,
Maria G. Calevo ,
Adriano Cipriani ,
Achille Pasquè  and
Sergio L. Chierchia
Vered Gilad*
Affiliation:
Cardiovascular Department, Istituto Clinico Ligure di Alta Specialità (ICLAS), Rapallo, Italy
Francesco Santoro
Affiliation:
Cardiovascular Department, Giannina Gaslini Institute, Genoa, Italy
Elena Ribera
Affiliation:
Cardiovascular Department, Giannina Gaslini Institute, Genoa, Italy
Maria G. Calevo
Affiliation:
UOSD Epidemiology, Biostatistics and Committees, Giannina Gaslini Institute, Genoa, Italy
Adriano Cipriani
Affiliation:
Cardiovascular Department, Istituto Clinico Ligure di Alta Specialità (ICLAS), Rapallo, Italy
Achille Pasquè
Affiliation:
Cardiovascular Department, Istituto Clinico Ligure di Alta Specialità (ICLAS), Rapallo, Italy
Sergio L. Chierchia
Affiliation:
Cardiovascular Department, Istituto Clinico Ligure di Alta Specialità (ICLAS), Rapallo, Italy
*
Correspondence to: V. Gilad, MD, Cardiovascular Department, Istituto Clinico Ligure di Alta Specialità (ICLAS), 11 Federico Sclopis Street, Genoa, 16147, Italy. Tel: +39 338 872 7012; Fax: +39 0185260973; E-mail: veredgilad@gmail.com
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Abstract

Background

Adults with CHD often exhibit complex cardiac abnormalities, whose management requires specific clinical and surgical expertise. To enable easier access of these patients to highly specialised care, we implemented a collaborative programme that incorporates medical and surgical specialists belonging to both paediatric and adult cardiovascular institutions.

Objectives

The objective of this study was to review the experience gained and to analyse the surgical outcome of major cardiac surgery.

Methods

We retrospectively reviewed all consecutive patients admitted for major cardiac surgery using our network between January, 2010 and December, 2013. Analysis of surgical outcome was performed in patients selected for major cardiac surgery with cardiopulmonary bypass. Early and late outcomes were evaluated.

Results

Out of a total of 433 inward patients, 86 were selected for surgery. The median age was 25.5 years, –64 patients (74.4%) had previously undergone heart surgery, and –55 patients (64%) had been subjected to at least one sternotomy. Abnormalities of the left ventricular and right ventricular outflow tract were the most frequent (37.2% and 30.2%, respectively), and despite high-surgical complexity only one death occurred (in-hospital mortality 1.1%). On a median follow-up time of 4 years no deaths and no heart-failure events have occurred; one patient underwent further cardiac surgery programmed at the time of discharge.

Conclusions

Low mortality and morbidity rates can be obtained in high-surgical complexity adults with CHD populations when paediatric and adult cardiac specialists operate in the same multidisciplinary environment.

Keywords

AdultCHDcardiac surgeryorganisation model
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 101 - 107
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Copyright
© Cambridge University Press 2017 

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