Results of biventricular repair of congenital cardiac malformations: Definitive corrective surgery?

Objectives: Congenital cardiac malformations are usually corrected in the neonatal period or in early infancy. Corrective surgery may not always be definitive, especially in complex malformations. Long-term morbidity is influenced by reoperations and their risk. Methods: This study analyzes our single-center experience over more than 20 years in a selected group of patients. Data were gathered, with special focus on causes and incidence for reoperations, respectively. Results: Freedom from reoperation after 5, 10, and 15 years for each cardiac malformation was determined. The numbers describe in the following order patient years (y), number of patients (n), and freedom from reoperation at follow-up interval (%), respectively: atrial septal defect (15 864y, n=1198, 99±0/99±0/99±0), partial atrioventricular septal defect (2506y, n=234, 95±2/93±2/93±2), total anomalous pulmonary venous connection (742y, n=141, 93±1/91±0/91±0), complete atrioventricular septal defect (1715y, n=377, 81±3/76±3/72±4), tetralogy of Fallot <1 year (1503y, n=197, 94±4/85±1/74±3), transposition of great arteries (1459y, n=375, 88±2/83±4/73±7), interrupted aortic arch (IAA) (481y, n=98, 63±6/52±7/45±8), common arterial trunk (CAT) (599y, n=109, 64±6/24±6/11±5). Conclusions: In most congenital malformations surgical correction is definitive and the rate of reoperations is low. In complex anomalies, such as CAT and IAA, reoperations at long-term are more common. Analysis of such results and recognition of a sometimes inevitable operative morbidity helps to predict long-term outcome and influences the follow-up.