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DOI: 10.1055/s-0035-1556037
Congenital Heart Surgery in Adults: Improvement of Surgical Performance despite Increasing Complexity
Background: The predictive power of the Aristotle Basic Complexity (ABC) and the Aristotle Comprehensive Complexity (ACC) score for hospital survival after congenital heart surgery has been demonstrated for adults. We sought to evaluate a potential change in complexity, hospital survival, and performance of congenital heart surgery in adults at a single center over a ten-year interval.
Methods and Results: Data of all consecutive patients aged 18 years or more, who underwent surgery for congenital heart disease between 2004 and 2013 at our institution, were collected. ABC and ACC scores were calculated according to the Aristotle Institute guidelines (Denver, USA). Performance was defined as complexity multiplied by hospital survival. Mean score values, hospital survival, and mean performance of 376 operations, performed from 2009 to 2013 were compared with 470 operations, performed from 2004 to 2008.
Mean ABC and ACC score were significantly higher in the recent five years compared with the previous five years, 7.39 ± 1.90 versus 6.64 ± 2.28, p < 0.001, and 9.60 ± 3.24 versus 8.95 ± 3.60, p = 0.006, respectively. Hospital survival was not significantly different between the recent and the previous five years, 97.1% versus 97.2%, p = 0.812. Surgical performance based on the ABC and ACC score were significantly higher in the recent five years, 7.16 ± 1.84 versus 6.41 ± 2.27, p < 0.001, and 9.31 ± 3.15 versus 8.65 ± 3.57, p = 0.004, respectively.
Conclusion: At our institution, we observed an increasing complexity in adult congenital heart surgery in the recent years compared with the previous years. However, hospital mortality did not increase. Therefore, surgical performance increased.