Three Decades of Surgery for Congenital Heart Disease: Factors Associated With Mortality

Abstract

Background: Although there are many reports of early and late outcomes following surgery for specific forms of congenital heart disease (CHD), there are few reports of the impact of CHD surgery in its entirety. In New Zealand, the vast majority of CHD surgery is undertaken by a single unit. Methods: Details of surgery for CHD from the Paediatric and Congenital Cardiac Service at Green Lane Hospital and Starship Children's Hospital were retrieved from departmental databases if the first operation occurred between 1985 and 2014. Mortality was verified by regular downloads from the Ministry of Health. Results: There were 6,128 patients with 8,091 operations. Survival at 10, 20, and 30 years was 90%, 88%, and 84%, respectively. Survival was worse for those operated on in the first decade (1985–1994) (p < 0.001) because of greater mortality over the first few months (Figure 1), neonates, those aged >40 years (p < 0.001), and those who underwent single ventricle palliation (p < 0.001). In this last patient group, there was a greater early hazard phase and a steeper late hazard function (Figure 2). Conclusion: Survival following CHD surgery improved over the past three decades. Despite an early hazard phase, particularly following neonatal surgery, and a higher risk for those undergoing palliative surgery, long-term survival is excellent.