Oliver et al identified risk factors for excess mortality in an adult with congenital heart disease. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Spain.
Patient selection: congenital heart disease
Factors with highest risk (standardized mortality ratio 16 to 29):
(1) single ventricle (univentricular) physiology
(2) clinical cyanosis
(3) pulmonary tract obstruction
Factors with standardized mortality ratio 6 to 11:
(1) infective endocarditis
(2) severe pulmonary hypertension
(3) subaortic AC valve regurgitation
(4) subpulmonary ventricular dysfunction
(5) systemic ventricular dysfunction
Factors with standardized mortality ratio from 2.6 to 3.8:
(1) aortic aneurysm
(2) atrial flutter or fibrillation
(3) ischemic heart disease
Risk factors with standardized mortality ratio from 1.5 to 2.5:
(1) aortic outflow tract obstruction
Diagnostic categories with standardized mortality ratios from 3 to 24):
(1) Ebstein anomaly
(2) atrioventricular septal defect
(3) coarctation of the aorta
(4) tetralogy of Fallot
(5) complete transposition of the great vessels
(6) atrioventricular discordance
(7) pulmonary atresia
Additional factors:
(1) complex congenital heart disease
(2) genetic syndrome
(3) nonrepairable
If no risk factors are present then the median age at death is 83.7 years.
If any risk factors are present then then the median age at death was 55.6 years.
