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J Thorac Cardiovasc Surg 2003;126:1048-1052
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Emergency hospital admissions and three-year survival of adults with and without cardiovascular surgery for congenital cardiac disease

^a Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Hertzentrum München, Technische Universität München, München, Germany
^b Department of Congenital Heart Defects and Pediatric Cardiology, Deutsches Hertzentrum Berlin, Berlin, Germany
^c Division of Cardiology, University Hospital Zürich, Zürich, Switzerland
^d Department of Cardiology, Deutsches Hertzentrum München, Technische Universität München, München, Germany

Received for publication December 19, 2002; revisions received January 28, 2003; revisions received March 5, 2003; accepted for publication April 30, 2003.

^* Address for reprints: Harald Kaemmerer, MD, VD, Deutsches Hertzentrum München, Department of Pediatric Cardiology and Congenital Heart Disease, Lazarettstraße 36, D-80636 München, Germany
Kaemmerer{at}dhm.mhn.de

OBJECTIVE:: This study determined the quantity and nature of emergencies leading to unscheduled hospital admissions of adults with congenital cardiac disease and their mid-term survival.

RESULTS: During 1 year, 429 adults with congenital cardiac diseases were admitted 571 times, and 124 admissions (22%) of 95 patients (22%) were emergency admissions. Fifteen of the 95 patients were seen for the first time in 1 of the participating centers. The underlying anomalies were Fallot's tetralogy and pulmonary atresia (n = 26/7), univentricular heart after Fontan procedure (n = 25), atrial septal defect (n = 18), Eisenmenger syndrome (n = 12), complete transposition (n = 11), and others (n = 25). Indications for admission were cardiovascular complications (n = 103; 83%) (arrhythmia, cardiac failure, syncope, pacemaker problems, pericardial tamponade, and sudden death), infections (n = 8, 6%) (endocarditis, pacemaker infection, pneumonia, and cerebral abscess), acute chest pain (n = 7; 6%), and acute abdominal pain (n = 4; 3%). All patients required immediate emergency care, and 16 patients (17%) required urgent cardiovascular or abdominal surgery. Six patients died during the hospital stay. During a follow-up of 2.9 years (SD 0.8), 16 (18%) of the discharged patients died, and 2 additional patients underwent heart or heart-lung transplantation.

CONCLUSION: Adults with congenital cardiac disease often experience serious emergency situations with a high in-hospital and mid-term post-hospital mortality. Care given by physicians with special expertise is important in this specific group of patients.