Causes of Late Deaths After Pediatric Cardiac Surgery
Open accessAbstract
Objectives We examined the causes and modes of late death after pediatric cardiac surgery.Background The late mortality of patients operated on for congenital heart defect (CHD) is comprehensively unexamined. In this study, the causes of death were examined to obtain further knowledge of the morbidity of the patients.Methods We studied all late deaths of patients operated on for CHD in Finland during the years 1953 to 1989. We calculated the survival of patients, identified the causes of deaths from death certificates, and examined the modes of CHD-related deaths. We compared the survival and the causes of non-CHD-related deaths to those of the general population.Results Of the 6,024 patients who survived their first operation, 592 (9%) died during the 45-year follow-up period. The progress of treatment was seen in the survival of the patients operated on in different decades. The cause of death was confirmed with postmortem examination in 474 (81%) cases. The majority of patients (397, 67%) died owing to the CHD. Furthermore, non-CHD-related mortality was twice as high (risk ratio 1.9, 95% confidence interval 1.5 to 2.4) as expected. The main mode for CHD-related death was heart failure (40%). Other modes included perioperative (26%), sudden (22%), and cardiovascular (12%) deaths. The number of deaths caused by neurological and respiratory diseases was higher and the number of accidental deaths was lower than expected.Conclusions The survival of patients was lower than that of the general population (relative 45-year survival 89%). Most patients died owing to CHDs, but non-CHD-related mortality was also high.
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Atrial tachycardias and impaired ventricular function are important and consistent risk factors for SCD in CHD; corrected Tetralogy of Fallot, post-atrial switch Mustard or Senning, left heart obstructed lesions and univentricular hearts have the highest (2-9% per decade) risk of SCD.
“Atrial tachycardias and impaired ventricular function are important and consistent risk factors for SCD in patients with CHD, of which corrected Tetralogy of Fallot, post-atrial switch operation Mustard or Senning, left heart obstructed lesions and univentricular hearts have the highest (2 -9% per decade) risk of SCD.352 -354”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [353]
Even though the incidence of SCD is low (0.09% per year) in the CHD population, it is higher than in age-matched controls, and related to arrhythmias in 14% of all deaths after initial repair.
“Even though the incidence of SCD is low (0.09% per year) in the CHD population, it is higher than in age-matched controls, 351 and related to arrhythmias in 14% of all deaths after initial repair.352,353”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [353]
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- Authors
- Nieminen, H. P., Jokinen, E. V., & Sairanen, H. I.
- Affiliations
- Helsinki University Hospital (FI)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 50
- Issue
- 13
- Pages
- 1263-1271
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W61894324
- Cited by
- 236
- References
- 36
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 11 · 2023: 7 · 2022: 6 · 2021: 15 · 2020: 10 · 2019: 10 · 2018: 23 · 2017: 24 · 2016: 12 · 2015: 16 · 2014: 15 · 2013: 15 · 2012: 14
- FWCI
- 6.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- late mortality, pediatric cardiac surgery, congenital heart disease, causes of death, heart failure, long-term survival, sudden death, neurological disorders, accidental death, cardiovascular mortality
- MeSH terms
- Accidents, Adolescent, Cause of Death, Child, Child, Preschool, Death, Sudden, Female, Finland, Heart Defects, Congenital, Heart Failure, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Registries, Suicide, Survival Analysis, Sex Distribution
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