Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

Purpose The aims of our study are twofold: first, to retrospectively identify the demographic characteristics and outcomes in cardiac surgery for adult congenital heart disease (ACHD); second, to explore whether certain preoperative examinations are useful for assessing the risk of perioperative mortality and morbidity. Methods Ninety-two ACHD patients who underwent cardiac surgery from 2009 to 2011 were enrolled in the study. The subjects were classified into three groups based on the complexity of the ACHD. We retrospectively collected data on demographics, operations, and postoperative courses. We also collected the results of examinations performed in the three months leading up to the cardiac surgery, including exercise tolerance testing and measurement of brain natriuretic peptide (BNP). Results The 30-day mortality was 3.3%. A remarkable discrepancy was found between subjective assessment and the severity of exercise intolerance by exercise tolerance testing. The NYHA class was 1 or 2 in all but one of 13 patients with moderate-severe exercise intolerance and a high mortality/major complication rate (53.8%). Patients with BNP ≧≧ 100 pg/ml had a significantly higher mortality/major complication rate than patients with BNP < 100 (34.8% vs. 11.5%, p < 0.05), but the sensitivity (53.3%) and positive predictive value (34.8%) were not high enough in themselves to identify patients at high risk of poor outcome. Conclusion Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery.