Pediatric cardiac surgery occurring at earlier age, with better outcomes over 50+ year review

1. Survival at 22 years was improved across all types of pediatric cardiac surgery when comparing those operated on between 1953-1989 and 1990-2009.

2. Mean age at operation decreased from 5.2 years from 1953-1989 to 2.0 years from 1990-2009.

Evidence Rating Level: 1 (Excellent)  

Study Rundown: Past studies evaluating pediatric cardiac surgery have suffered from limitations including patients isolated at a single center, small sample size, or incomplete duration or coverage of follow-up. This study, via the Finnish Population Registry, sought to holistically characterize outcomes and their progression in a wide variety of pediatric cardiac surgery over a period of 60 years in Finland. The study was able to achieve comprehensive follow-up in over 98% of all Finnish patients undergoing pediatric cardiac surgery from 1958 to 2009. Researchers found improved early and late mortality outcomes in all patients undergoing any type of procedure for a cardiac defect from 1990-2009 compared to those from 1958-1989. Patients who underwent relatively “simple” operations such atrial septal defect (ASD) repair or patent ductus arteriosus (PDA) ligation demonstrated equivalent average lifespans to the general population throughout the entire duration of the study. By contrast, in more complex procedures for patients with aortic coarctation or ventricular septal defects (VSD), 20-year survival rates were only equal to the general population if operated on between 1990 and 2009. The study is significant for its characterization of improved outcomes over time in the setting of pediatric cardiac surgery, particularly more complex procedures. This is likely attributable to improvements in surgical technique, medical therapy, and post-operative care.  Limitations included the retrospective analysis of a data registry which prevented extensive follow-up data from each patient and single country design, which limited the heterogeneity of the patient population and surgical technique of the analyzed operations.

Click to read the study in Circulation

Click to read an accompanying editorial in Circulation

Relevant Reading: Late Results of Pediatric Cardiac Surgery in Finland A Population-Based Study With 96% Follow-Up

In-Depth [retrospective cohort]: All cardiac operations in children under the age of 15 performed in Finland from 1953 to 2009 were included in the analysis. Follow-up was collected for all patients, where applicable, until October 24, 2012. All operations were performed at the Helsinki University Children’s Hospital beginning in 1997. A total of 13 786 operations on 10 964 patients were performed during the study period. Follow-up was collected in 98% of patients. Those lost to follow-up included those who emigrated (1.6%) and those with insufficient data (0.4%). Patients were stratified on the basis of their congenital heart defect, including PDA, ASD, coarctation of aorta (COA), VSD, tetralogy of Fallot, transposition of the great arteries, hypoplastic left heart syndrome, and univentricular heart.  Mean and median age at operation gradually decreased across all groups from the 1950’s to the 2000’s (p<0.0001). Early mortality (<30 days postoperatively) decreased across all groups in later decades with the exception of PDA, ASD, and COA groups, due to high survival rates across all decades. Survival was compared across all groups between the years of 1953-1989 and 1990-2009, respectively.

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