Postoperative Mortality and Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiovascular Surgery ― Insights From the Japanese Registry Data ―
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Patients with adult congenital heart disease (ACHD) are prone to complications and usually require surgical intervention, but the surgical risk factors remain poorly defined. Methods and Results: We analyzed data from April 2013 to March 2023 in the nationwide Japanese Registry of All Cardiac and Vascular Disease-Diagnostic Procedure Combination (JROAD-DPC) to assess postoperative cardiac death and its predictors. This study included ACHD patients aged ≥18 years who underwent cardiovascular surgery, and the primary outcome was in-hospital death. A total of 10,535 patients (median age 53 [interquartile range 36-68] years; 50.4% female) were classified into mild (n=6,831), moderate (n=2,388), and severe (n=1,316) complexity groups. Among the 146 in-hospital deaths (1.4%), the highest mortality rate was observed in patients with severe complexity (2.4%). Multivariable analysis showed that age (hazard ratio [HR] 1.15), severe complexity (HR 1.77), renal disease (HR 1.74), pulmonary hypertension requiring medications (HR 2.01), chromosome abnormality (HR 6.22), and high-risk surgery (Fontan surgery or coronary artery bypass grafting) (HR 1.67) were significantly associated with increased in-hospital deaths. Subgroup analyses showed that age, renal disease, and high-risk surgery were prognostic factors in the mild group. Age was not significant in the moderate or severe groups. Conclusions: The in-hospital mortality rate after cardiovascular surgery in ACHD was low overall but increased with disease complexity, supporting the need for disease complexity-based, individualized risk assessments in surgical planning.
Source: Circulation Reports
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221194581