Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index
Background Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery. Methods and Results This is a retrospecti...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010624 |
| _version_ | 1818312285617127424 |
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| author | Courtney McCracken Logan G. Spector Jeremiah S. Menk Jessica H. Knight Jeffrey M. Vinocur Amanda S. Thomas Matthew E. Oster James D. St Louis James H. Moller Lazaros Kochilas |
| author_facet | Courtney McCracken Logan G. Spector Jeremiah S. Menk Jessica H. Knight Jeffrey M. Vinocur Amanda S. Thomas Matthew E. Oster James D. St Louis James H. Moller Lazaros Kochilas |
| author_sort | Courtney McCracken |
| collection | DOAJ |
| description | Background Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery. Methods and Results This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58); P=0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9). Conclusions Survivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes. |
| first_indexed | 2024-12-13T08:15:25Z |
| format | Article |
| id | doaj.art-c1a0bb355a58467e969d06304c942863 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:15:25Z |
| publishDate | 2018-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c1a0bb355a58467e969d06304c9428632022-12-21T23:54:07ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-11-0172210.1161/JAHA.118.010624Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death IndexCourtney McCracken0Logan G. Spector1Jeremiah S. Menk2Jessica H. Knight3Jeffrey M. Vinocur4Amanda S. Thomas5Matthew E. Oster6James D. St Louis7James H. Moller8Lazaros Kochilas9Children's Healthcare of Atlanta Atlanta GADepartment of Pediatrics University of Minnesota Minneapolis MNBiostatistical Design and Analysis Center University of Minnesota Minneapolis MNDepartment of Epidemiology and Biostatistics University of Georgia School of Public Health Athens GADepartment of Pediatrics School of Medicine and Dentistry University of Rochester NYDepartment of Pediatrics Emory University School of Medicine Atlanta GAChildren's Healthcare of Atlanta Atlanta GADepartment of Pediatric Surgery University of Missouri‐Kansas City School of Medicine Kansas City MODepartment of Internal Medicine University of Minnesota Minneapolis MNChildren's Healthcare of Atlanta Atlanta GABackground Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery. Methods and Results This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58); P=0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9). Conclusions Survivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.118.010624congenital heart diseasemortalityoutcomes researchsurgery |
| spellingShingle | Courtney McCracken Logan G. Spector Jeremiah S. Menk Jessica H. Knight Jeffrey M. Vinocur Amanda S. Thomas Matthew E. Oster James D. St Louis James H. Moller Lazaros Kochilas Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease congenital heart disease mortality outcomes research surgery |
| title | Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index |
| title_full | Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index |
| title_fullStr | Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index |
| title_full_unstemmed | Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index |
| title_short | Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index |
| title_sort | mortality following pediatric congenital heart surgery an analysis of the causes of death derived from the national death index |
| topic | congenital heart disease mortality outcomes research surgery |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010624 |
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