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A unique milieu for perioperative care of adult congenital heart disease patients at a single institution.

PURPOSE
Adult patients with congenital heart disease presenting for cardiothoracic operation pose special demands for the arrangement of their perioperative care. This study describes the distinctive perioperative setup for adult congenital heart patients.


MATERIALS AND METHODS
A retrospective review of 48 adult congenital heart disease cases that received operative intervention from July 2000 to October 2005. Operative procedures and postoperative care were all exercised in the same unit by the same staff handling adult and pediatric cardiothoracic surgery cases.


RESULTS
Forty-two patients underwent definitive biventricular repair, and the remainder were subjected to palliative procedures. There were 2 cases of operative mortality: 1 patient died as a result of arrhythmia after Glenn procedure, and 1 died as a result of multiorgan failure secondary to sepsis after ventricular septal defect repair. Complications that prolonged intensive care stay for more than 72 hours were extracorporeal support for systemic right ventricular dysfunction (n = 1); reoperation for ventricular septal patch endocarditis after ventricular septal defect repair (n = 1); respiratory failure (n = 4); renal failure (n = 3); sepsis (n = 2); junctional tachycardia (n = 1); pulmonary hypertension (n = 2); and reperfusion injury of the lung (n = 2). Patients subjected to the Fontan operation had a longer hospital stay (mean = 33 days) as a result of pleural effusions. Forty-six patients were discharged home.


CONCLUSION
This distinctive environment allows our group to provide the appropriate care for our adult congenital heart disease patients in a well-integrated discipline. The frequent clinical exposure to both adult and pediatric cardiothoracic procedures has helped in facilitating the provision of optimum care to the patients with adult congenital heart disease.