Congenital Heart Surgery in Adults: Improvement of Surgical Performance Despite Increasing Mortality Risk Over 45 Years in German Heart Centre Munich

Objectives: Our retrospective study aimed to analyze the changes in the mortality risk and outcome in adults with congenital heart disease undergoing cardiac surgery, in the German Heart Centre Munich over a 45-year period.

Methods: All 2,882 consecutive operations performed on patients aged 18 or more, who underwent surgery for congenital heart disease at the German Heart Centre Munich, between 1974 and 2018, were analyzed. Mortality risk was estimated according to the Adult Congenital Heart Surgery (ACHS) mortality score. The outcome was defined as in-hospital mortality. Surgical performance was defined as the mean ACHS mortality score multiplied by in-hospital survival. Two-tailed chi-square test or two-tailed student's t-test was used to compare the mortality, ACHS mortality score and performance between the decades.

Result: Overall operative mortality was 3.2% and remained similar over the decades (p ranged from 0.206 to 1.000). The mean ACHS mortality score stayed on the same level between the 1970s and 1980s (p = 0.811) and between the 1980s and 1990s (p = 0.142). It then increased significantly in the 2000s (p < 0.001) and again in the 2010s (p = 0.022). The surgical performance based on the ACHS mortality score stayed similar between the 1970s and 1980s (p = 0.895) and between 1980s and 1990s (p = 0.211). It then increased significantly in the 2000s (p < 0.001) and again in the 2010s (p = 0.005).

	ACHS mortality score (mean ± SD)	In-hospital mortality	Surgical performance (mean ACHS mortality score × survival)
1974–1979	0.36 ± 0.30	4.2%	34.5
1980–1989	0.36 ± 0.35	3.2%	34.8
1990–1999	0.39 ± 0.43	3.2%	37,8
2000–2009	0.52 ± 0.45	2.7%	50.6
2010–2018	0.57 ± 0.43	3.2%	55.2

Conclusion: The mean ACHS mortality score increased significantly over the past 45 years in adults with congenital heart disease undergoing cardiac surgery in the German Heart Center in Munich. The mortality stayed the same. Therefore, the surgical performance based on the ACHS mortality score increased significantly over the years.

Publication History

Article published online:
19 February 2021