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Surgical Outcomes of Adult Congenital Heart Disease with Left to Right Shunt at Siriraj Hospital.

Background
Outcomes of surgical treatment of adult congenital heart disease (ACHD) in developing country are scant but are of critical importance for caring of these patients.


Objective
We studied characteristic and surgical repair outcomes of simple ACHD at Siriraj Hospital.


Material and Method
We studied 297 adults with atrial septal defect (ASD), ventricular septal defect (VSD), or patent ductus arteriosus (PDA) whom underwent surgical repair between January 2006 and September 2014. There were 211 ASD, 80 VSD, and 6 PDA. We focused on perioperative data, follow-up data, and factor(s) associated with adverse events.


Results
Of 297 patients, 37.4% were males; mean age was 41.8 years (range, 20-78 years). Pulmonary hypertension and valvular regurgitation (mitral, tricuspid, or aortic) were presented in 74.7% and 35.0% of the patients, respectively. Majority of defects were closed with patching (85.4% for ASD and 82.7% for VSD), while the rest were closed directly. Of the 190 concomitant procedures, most of them were tricuspid repair (28.9%), and mitral repair (17.4%). There were eight hospital deaths (2.7%). At median follow-up of 25 months (range, 1-102 months), the mean functional classification was reduced from 1.9 to 1.1 (p<0.01). There were five re-interventions and four late deaths. Overall survival was 96.1% at five years and 76.1% at eight years. Concomitant procedure(s), tricuspid, and mitral regurgitation were associated with worse survival. Concomitant procedure(s), mitral, and aortic regurgitation were associated with re-intervention.


Conclusion
Outcomes of surgical repair of simple ACHD were good. Valvular regurgitation and concomitant procedure(s) adversely affected the outcomes.