In the Journals

Survival after interventional treatment for congenital heart disease improving

Interventional treatment of congenital heart disease has progressed during the past 40 years and has led to improved survival rates, although survival remains lower than the general population, according to a study in the Journal of the American College of Cardiology.

Signe H. Larsen, MD, PhD, of the department of cardiology at Aarhus University Hospital in Denmark, and colleagues reviewed data from 9,372 children younger than 18 years from Denmark who were treated for congenital heart disease from 1977 to 2015. Each patient was matched by birth year and sex to 10 control patients. Years were split into three periods: 1977 to 1989, 1990 to 2002 and 2003 to 2015.

Catheter-based interventions before 1990 were not analyzed, as codes for specific interventions were not classified until then. Patients were followed up for a median of 14 years.

Surgeries and interventions

Within the study period, the cohort underwent 1,912 catheter-based interventions and 11,968 cardiac surgeries. The median age of a patient’s first procedure decreased over time, from 3.4 years from 1977 to 1989 (5th percentile, 0.01 years; 95th percentile, 15.4 years), 0.8 years from 1990 to 2002 (5th percentile, 0.003 years; 95th percentile, 13.8 years) and 0.6 years from 2003 to 2015 (5th percentile, 0 years; 95th percentile, 14.9 years). Rate of preterm births at less than 37 weeks increased from 6.7% from 1977 to 1989 to 18.5% from 2003 to 2015.

“During the three time periods, the age at first operation decreased and the frequency of prematurity increased similar to other reports,” Larsen and colleagues wrote. “This probably reflected advances in surgical techniques and improved neonatal care, enabling treatment of still more complex lesions in younger children.”

Patients treated with catheter-based intervention increased from 202 (5.8%) from 1990 to 2002 to 871 (25.9%) from 2003 to 2015. Rates of those who had no surgeries rose from 169 patients (4.8%) from 1990 to 2003 to 806 (24%) from 2003 to 2015.

Thirty-day survival in all patients with congenital heart disease increased from 97% (95% CI, 97-98) from 1977 to 1989 to 98% (95% CI, 98-99) from 1990 to 2002 and 100% (95% CI, 99-100) from 2003 to 2015. The prevalence of 10-year survival also increased from 80% (95% CI, 79-82) to 87% (95% CI, 86-88) and 93% (95% CI, 92-95) among the three time periods.

Simple and complex congenital heart disease were linked to lower survival compared with the background population throughout all time periods.

“The use of catheter-based interventions has increased since 1990, and some defects can now be treated with catheter-based intervention alone,” Larsen and colleagues wrote. “The survival time for both simple and complex [congenital heart disease] has increased. However, survival remains significantly reduced compared with the background population and a large part of the [congenital heart disease] population still needs new cardiac surgeries or catheter-based interventions.”

Kathy J. Jenkins
Kathy J. Jenkins

Dedicated resources

“Perhaps in time, parents in Denmark and elsewhere will feel more optimistic about the quality of life their children with [congenital heart disease] will experience,” Kathy J. Jenkins, MD, MPH, senior associate in cardiology, senior vice president and chief safety and quality officer at Boston Children’s Hospital and professor of pediatrics at Harvard Medical School, wrote in a related editorial. “This will only occur if countries with limited resources find a way to provide reliable treatments for [congenital heart diseases] as is the story in Denmark, and if countries with more resources dedicate them to secondary prevention.” – by Darlene Dobkowski

Disclosure: The researchers report no relevant financial disclosures. Jenkins reports receiving study grants from Medtronic and NuMed, and free drugs for a research study from Novartis.

 

Interventional treatment of congenital heart disease has progressed during the past 40 years and has led to improved survival rates, although survival remains lower than the general population, according to a study in the Journal of the American College of Cardiology.

Signe H. Larsen, MD, PhD, of the department of cardiology at Aarhus University Hospital in Denmark, and colleagues reviewed data from 9,372 children younger than 18 years from Denmark who were treated for congenital heart disease from 1977 to 2015. Each patient was matched by birth year and sex to 10 control patients. Years were split into three periods: 1977 to 1989, 1990 to 2002 and 2003 to 2015.

Catheter-based interventions before 1990 were not analyzed, as codes for specific interventions were not classified until then. Patients were followed up for a median of 14 years.

Surgeries and interventions

Within the study period, the cohort underwent 1,912 catheter-based interventions and 11,968 cardiac surgeries. The median age of a patient’s first procedure decreased over time, from 3.4 years from 1977 to 1989 (5th percentile, 0.01 years; 95th percentile, 15.4 years), 0.8 years from 1990 to 2002 (5th percentile, 0.003 years; 95th percentile, 13.8 years) and 0.6 years from 2003 to 2015 (5th percentile, 0 years; 95th percentile, 14.9 years). Rate of preterm births at less than 37 weeks increased from 6.7% from 1977 to 1989 to 18.5% from 2003 to 2015.

“During the three time periods, the age at first operation decreased and the frequency of prematurity increased similar to other reports,” Larsen and colleagues wrote. “This probably reflected advances in surgical techniques and improved neonatal care, enabling treatment of still more complex lesions in younger children.”

Patients treated with catheter-based intervention increased from 202 (5.8%) from 1990 to 2002 to 871 (25.9%) from 2003 to 2015. Rates of those who had no surgeries rose from 169 patients (4.8%) from 1990 to 2003 to 806 (24%) from 2003 to 2015.

Thirty-day survival in all patients with congenital heart disease increased from 97% (95% CI, 97-98) from 1977 to 1989 to 98% (95% CI, 98-99) from 1990 to 2002 and 100% (95% CI, 99-100) from 2003 to 2015. The prevalence of 10-year survival also increased from 80% (95% CI, 79-82) to 87% (95% CI, 86-88) and 93% (95% CI, 92-95) among the three time periods.

Simple and complex congenital heart disease were linked to lower survival compared with the background population throughout all time periods.

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“The use of catheter-based interventions has increased since 1990, and some defects can now be treated with catheter-based intervention alone,” Larsen and colleagues wrote. “The survival time for both simple and complex [congenital heart disease] has increased. However, survival remains significantly reduced compared with the background population and a large part of the [congenital heart disease] population still needs new cardiac surgeries or catheter-based interventions.”

Kathy J. Jenkins
Kathy J. Jenkins

Dedicated resources

“Perhaps in time, parents in Denmark and elsewhere will feel more optimistic about the quality of life their children with [congenital heart disease] will experience,” Kathy J. Jenkins, MD, MPH, senior associate in cardiology, senior vice president and chief safety and quality officer at Boston Children’s Hospital and professor of pediatrics at Harvard Medical School, wrote in a related editorial. “This will only occur if countries with limited resources find a way to provide reliable treatments for [congenital heart diseases] as is the story in Denmark, and if countries with more resources dedicate them to secondary prevention.” – by Darlene Dobkowski

Disclosure: The researchers report no relevant financial disclosures. Jenkins reports receiving study grants from Medtronic and NuMed, and free drugs for a research study from Novartis.