Signe H Larsen1, Morten Olsen2, Kristian Emmertsen3, Vibeke E Hjortdal4. 1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: signe_holm_larsen@hotmail.com. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 3. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 4. Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND: The treatment of congenital heart (CHD) has changed rapidly. OBJECTIVES: The authors reviewed CHD treatment through a 39-year nationwide population-based study on congenital heart surgery and catheter-based interventions, unbiased by referral patterns. METHODS: Using medical registries, the authors identified children (<18 years of age) treated for CHD in Denmark from 1977 to 2015, their need for reinterventions, and their long-term survival. Ten controls per patient, matched by sex and year of birth, allowed comparison with the background population. Survival was described using Kaplan-Meier curves. RESULTS: A total of 9,372 patients underwent 11,968 cardiac surgeries and 1,912 catheter-based interventions. Median age at first procedure decreased from 3.4 years (5th and 95th percentiles: 0.01 to 15.4 years) in 1977 to 1989 (period 1), 0.8 years (5th and 95th percentiles: 0.003 to 13.8 years) in 1990 to 2002 (period 2), and to 0.6 years (5th and 95th percentiles: 0.0 to 14.9 years) in 2003 to 2015 (period 3). More patients were born preterm (<37 weeks) in period 3 compared with those in period 1 (18.5% vs. 6.7%). Catheter-based interventions, not recorded before 1990, were increasingly used as the initial procedure in 5.8% of patients in period 2 and 25.9% of patients in period 3. An increasing part of the population did not undergo surgery at all (4.8% in period 2; 24.0% in period 3). Thirty-day survival increased from 97% (period 1) to 98% (period 2) to 100% (period 3). Ten-year survival increased from 80% (period 1) to 87% (period 2) to 93% (period 3). Compared with the background population, CHD was associated with lower survival in all 3 time periods. CONCLUSIONS: Interventional treatment of CHD has evolved from 1977 to 2015 and is now performed on younger and more preterm patients, often with catheter-based interventions. However, compared with the background population, survival remains significantly reduced.
BACKGROUND: The treatment of congenital heart (CHD) has changed rapidly. OBJECTIVES: The authors reviewed CHD treatment through a 39-year nationwide population-based study on congenital heart surgery and catheter-based interventions, unbiased by referral patterns. METHODS: Using medical registries, the authors identified children (<18 years of age) treated for CHD in Denmark from 1977 to 2015, their need for reinterventions, and their long-term survival. Ten controls per patient, matched by sex and year of birth, allowed comparison with the background population. Survival was described using Kaplan-Meier curves. RESULTS: A total of 9,372 patients underwent 11,968 cardiac surgeries and 1,912 catheter-based interventions. Median age at first procedure decreased from 3.4 years (5th and 95th percentiles: 0.01 to 15.4 years) in 1977 to 1989 (period 1), 0.8 years (5th and 95th percentiles: 0.003 to 13.8 years) in 1990 to 2002 (period 2), and to 0.6 years (5th and 95th percentiles: 0.0 to 14.9 years) in 2003 to 2015 (period 3). More patients were born preterm (<37 weeks) in period 3 compared with those in period 1 (18.5% vs. 6.7%). Catheter-based interventions, not recorded before 1990, were increasingly used as the initial procedure in 5.8% of patients in period 2 and 25.9% of patients in period 3. An increasing part of the population did not undergo surgery at all (4.8% in period 2; 24.0% in period 3). Thirty-day survival increased from 97% (period 1) to 98% (period 2) to 100% (period 3). Ten-year survival increased from 80% (period 1) to 87% (period 2) to 93% (period 3). Compared with the background population, CHD was associated with lower survival in all 3 time periods. CONCLUSIONS: Interventional treatment of CHD has evolved from 1977 to 2015 and is now performed on younger and more preterm patients, often with catheter-based interventions. However, compared with the background population, survival remains significantly reduced.
Authors: Logan G Spector; Jeremiah S Menk; Jessica H Knight; Courtney McCracken; Amanda S Thomas; Jeffrey M Vinocur; Matthew E Oster; James D St Louis; James H Moller; Lazaros Kochilas Journal: J Am Coll Cardiol Date: 2018-05-29 Impact factor: 24.094
Authors: Camilla Omann; Camilla Nyboe; Rasmus Kristensen; Andreas Ernst; Cecilia Høst Ramlau-Hansen; Charlotte Rask; Ann Tabor; J William Gaynor; Vibeke E Hjortdal Journal: Eur Heart J Open Date: 2022-04-21
Authors: Benjamin Asschenfeldt; Lars Evald; Johan Heiberg; Camilla Salvig; Leif Østergaard; Rikke Beese Dalby; Simon Fristed Eskildsen; Vibeke Elisabeth Hjortdal Journal: J Am Heart Assoc Date: 2020-05-19 Impact factor: 5.501
Authors: Courtney McCracken; Logan G Spector; Jeremiah S Menk; Jessica H Knight; Jeffrey M Vinocur; Amanda S Thomas; Matthew E Oster; James D St Louis; James H Moller; Lazaros Kochilas Journal: J Am Heart Assoc Date: 2018-11-20 Impact factor: 5.501
Authors: Mehreen Farooqi; John Stickley; Rami Dhillon; David J Barron; Oliver Stumper; Timothy J Jones; Paul F Clift; William J Brawn; Nigel E Drury Journal: Heart Date: 2019-02-16 Impact factor: 5.994
Authors: Kate E Best; Nicola Miller; Elizabeth Draper; David Tucker; Karen Luyt; Judith Rankin Journal: Front Pediatr Date: 2021-07-06 Impact factor: 3.418