30 YEARS OF EXPERIENCE ON GROWN-UP CONGENITAL HEART DISEASE

Background: Congenital heart diseases (CHD) represent the main cause of mortality associated with defects in newborns. Due to last decades developments, 95% of children with CHD are reported to survive to adulthood. This wide population of adults, known as GUCH, now significantly exceeds the pediatric population and is continuously increasing. Methods/Results: We retrospectively enrolled 807 GUCH patients, aged 18 years and over, who underwent cardiac surgery between January 1993 and December 2022. Data were analyzed dividing the group into two equal periods (eras) of 15 years. Totally 836 procedures were performed on 807 patients: 574 procedures on 561 patients in the first era and 262 operations on 246 patients in the second. Mean age was 41.6 years in the first era and 36.3 years in the second. Patients undergoing operations presented with increasingly complex defects in second era. Moderate and complex diseases increased from 38.5% and 6.8% to 61.5% and 19.5%, respectively (p=0.0001 and p=0.06); simple defects were 54.7% in first era and 19.0% in second (p<0.0001). Mean Aristotle score increased from 4.9 to 6.1. Conclusions: The spectrum of surgery in adult CHD changed significantly over decades. We noted a significant increase of reoperations from first to second era. Surgery changed from primary repair of septal defects to complex reoperations as treatment of residual defects or sequelae of the initial pathology or previous treatment. In upcoming years, we expect that acquired heart disease will mix with adult CHD and with the onset of newer pathologies deriving from their primary surgery.