Wilamarta Karina V, Yuniadi Yoga, Rachmat Jusuf, Fakhri Dicky, Hakim Tarmizi, Anwar Maizul
Department of Cardiac Surgery, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Cardiol Young. 2011 Dec;21(6):639-45. doi: 10.1017/S1047951111000552. Epub 2011 May 24.
Successful paediatric cardiac surgery and cardiology treatment has resulted in an increase in the use of surgery as a method of treatment of congenital cardiac disease in adult population. However, late detection and lower socio-economic condition in developing countries might change patients' characteristics by the time they come for treatment. This study aimed to elaborate the long-term surgical results of adult congenital cardiac disease in Indonesia as a developing country.
We reviewed retrospectively all adult congenital cardiac disease patients with a mean age of 28 years plus or minus 9.5 years, who underwent surgery at National Cardiovascular Center. The types of procedures used were corrective in 338 patients (89.2%), palliative in 10 patients (2.6%), and re-operations in 31 patients (8.2%). The overall hospital mortality rate was 2.6% but as high as 20% with palliative surgery. Post-operative New York Heart Association class III-IV is the only independent predictor of death at 60 months (hazard ratio 61.48, 95% confidence interval 9.41-401.69, p<0.001). The survival rates were 96.3% and 95% for overall and non-atrial septal defect in patients at 60 months, which was highest in corrective procedures (97.6%). The percentage of patients free of re-operation at 5 years' follow-up was 85.4% and 42.7% at 10 years.
In developing countries, surgical treatment of adult congenital cardiac disease is effective and safe, with an overall survival rate of 96.3% at 60 months. Due to high mortality rate, palliative surgery of a non-atrial septal defect patient is recommended to be discontinued. The independent predictor of mortality was post-operative New York Heart Association functional class III-IV.
成功的小儿心脏外科手术和心脏病治疗使得在成年人群中使用手术治疗先天性心脏病的情况有所增加。然而，发展中国家的晚期诊断和较低的社会经济状况可能会在患者前来治疗时改变其特征。本研究旨在阐述作为发展中国家的印度尼西亚成年先天性心脏病患者的长期手术结果。
我们回顾性分析了所有在国家心血管中心接受手术的成年先天性心脏病患者，这些患者的平均年龄为28岁加减9.5岁。所采用的手术类型中，338例（89.2%）为矫正性手术，10例（2.6%）为姑息性手术，31例（8.2%）为再次手术。总体医院死亡率为2.6%，但姑息性手术的死亡率高达20%。术后纽约心脏协会III-IV级是60个月时死亡的唯一独立预测因素（风险比61.48，95%置信区间9.41-401.69，p<0.001）。60个月时，总体患者和非房间隔缺损患者的生存率分别为96.3%和95%，矫正性手术的生存率最高（97.6%）。5年随访时无再次手术的患者百分比为85.4%，10年时为42.7%。
在发展中国家，成年先天性心脏病的手术治疗是有效且安全的，60个月时的总体生存率为96.3%。由于死亡率高，建议停止对非房间隔缺损患者进行姑息性手术。死亡的独立预测因素是术后纽约心脏协会功能分级III-IV级。
