Nationwide Danish Study Evaluates 39 Years of Interventional Treatment for Congenital Heart Disease
May 30, 2017—In a study published online in Journal of the American College of Cardiology (JACC), Signe H. Larsen, MD, et al evaluated the experience of 39 years of interventional treatment for patients with congenital heart disease in Denmark. The investigators concluded that interventional treatment of congenital heart disease has evolved from 1977 to 2015 and is now performed on younger and more preterm patients, often with catheter-based interventions. However, compared with the background population, survival remains significantly reduced.
As summarized in JACC, the investigators reviewed treatment through a 39-year, nationwide population–based study on congenital heart surgery and catheter-based interventions, unbiased by referral patterns. Using medical registries, the investigators identified children (younger than 18 years) treated for congenital heart disease in Denmark from 1977 to 2015 and determined their need for reinterventions and their long-term survival. Ten controls per patient, matched by sex and year of birth, allowed comparison with the background population. Survival was described using Kaplan-Meier curves.
The investigators found that a total of 9,372 patients underwent 11,968 cardiac surgeries and 1,912 catheter-based interventions. Median age at the time of the first procedure decreased from 3.4 years (5th and 95th percentiles, 0.01–15.4 years) in 1977 to 1989 (period 1), 0.8 years (5th and 95th percentiles, 0.003–13.8 years) in 1990 to 2002 (period 2), and to 0.6 years (5th and 95th percentiles, 0.0–14.9 years) in 2003 to 2015 (period 3). More patients were born preterm (before 37 weeks) in period 3 compared with those in period 1 (18.5% vs 6.7%).
Catheter-based interventions, which not recorded before 1990, were increasingly used as the initial procedure in 5.8% of patients in period 2 and 25.9% of patients in period 3. An increasing part of the population did not undergo surgery at all (4.8% in period 2; 24.0% in period 3). Thirty-day survival increased from 97% (period 1) to 98% (period 2) to 100% (period 3). Ten-year survival increased from 80% (period 1) to 87% (period 2) to 93% (period 3). Compared with the background population, congenital heart disease was associated with lower survival in all three time periods, reported the investigators in JACC.