Cardiac surgery in adults with congenital heart disease: an African perspective
© Long et al. 2015
Published: 16 December 2015
A paucity of data exists on the spectrum and outcome of adult patients undergoing congenital heart surgery (CHS) on the African continent.
This study was undertaken to understand the local disease profile and needs of this patient group and so to facilitate planning for future provision of cardiac services.
A retrospective chart review was undertaken of all consecutive adult patients (≤ 18 years) undergoing CHS in a single African tertiary care hospital between October 1995 and January 2015. Patients and operative outcomes were described using the Society of Thoracic Surgeons CHS database form.
A total of 220 operations were performed in 209 patients (45% male). Mean age at surgery was 30,1 ± 10,9 years. Preoperative diagnostic cardiac catheterization was performed in 86,3% of patients. The most common lesions according to primary diagnostic category were as follows: Septal defects (43,6%), Right heart lesions, including Conduit failure (23,7%), Left heart lesions (10,5%) and Thoracic arteries and veins (8,6%). Single ventricle lesions comprised 2,7% of diagnoses. Fifty-four percent of patients presented in the moderate or complex Bethesda diagnostic classes. Preoperative risk factors were present in 19,1% of patients with endocarditis, renal dysfunction and severe pulmonary hypertension the most frequent. Reoperations constituted 28,6% of procedures performed. Right ventricle to pulmonary artery conduit placement constituted 50,8% of the reoperations. Overall operative mortality was 1,8% (n = 4) with 4,8% (n = 3) mortality in the reoperation group. Postoperative complications occurred in 26,8% of patients. The mean Aristotle Basic Score was 6,2 ± 2.4.
Surgical treatment is feasible in the African context with low mortality and acceptable morbidity in spite of limited resources. Our patient profile was similar to that reported in a recent multicentre European series. Our utilization of diagnostic cardiac catheterization seemed excessive. More than half of our patient group will require long-term specialized care.
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