{
  "abstract": "Background\n\nPatients 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\n\nWe 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\n\nThe 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Institute of Medicine, University of Tsukuba Ibaraki Japan.",
    "Laboratory of Mathematical Informatics in Medicine, Institute of Medicine, University of Tsukuba Ibaraki Japan.",
    "Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan.",
    "Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan.",
    "Department of Pediatrics, Institute of Medicine, University of Tsukuba Ibaraki Japan.",
    "Department of Cardiology, Fukuoka Children's Hospital Fukuoka Japan.",
    "Department of Cardiovascular Surgery, Institute of Medicine, University of Tsukuba Ibaraki Japan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Takumi Osawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Tomoko Machino-Ohtsuka"
    },
    {
      "affs": [
        1
      ],
      "name": "Keitaro Kume"
    },
    {
      "affs": [
        1
      ],
      "name": "Takahiro Yano"
    },
    {
      "affs": [
        2
      ],
      "name": "Mike Saji"
    },
    {
      "affs": [
        3
      ],
      "name": "Koshiro Kanaoka"
    },
    {
      "affs": [
        3
      ],
      "name": "Yoko Sumita"
    },
    {
      "affs": [
        4
      ],
      "name": "Yusuke Yano"
    },
    {
      "affs": [
        0
      ],
      "name": "Ruriko Numata"
    },
    {
      "affs": [
        0
      ],
      "name": "Naoto Kawamatsu"
    },
    {
      "affs": [
        5
      ],
      "name": "Ayako Kuraoka"
    },
    {
      "affs": [
        6
      ],
      "name": "Hideyuki Kato"
    },
    {
      "affs": [
        6
      ],
      "name": "Yuji Hiramatsu"
    },
    {
      "affs": [
        0
      ],
      "name": "Tomoko Ishizu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9ebxheyvy28s0.bib",
  "cited_by": 0,
  "doi": "10.1253/circrep.cr-26-0064",
  "fulltext_url": "https://europepmc.org/articles/PMC13747981",
  "id": "9ebxheyvy28s0",
  "issns": [
    "2434-0790"
  ],
  "landing_url": "https://europepmc.org/article/MED/43010985",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "heading",
      "Pediatric Cardiology and Adult Congenital Heart Disease"
    ],
    [
      "openalex",
      "2705|Congenital Heart Disease Studies"
    ]
  ],
  "openalex": "W7221194581",
  "pdf_url": "https://europepmc.org/articles/PMC13747981?pdf=render",
  "pmcid": "PMC13747981",
  "pmid": "43010985",
  "published": "2026-10-10",
  "publisher": "The Japanese Circulation Society",
  "ris": "https://research.draconitic.com/paper/9ebxheyvy28s0.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T15:22:43Z",
      "native_id": "MED:43010985",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43010985"
    },
    {
      "first_seen": "2026-11-13T12:25:34Z",
      "native_id": "PMC13747981",
      "source": "pmc",
      "url": "https://doi.org/10.1253/circrep.cr-26-0064"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Congenital Heart Disease Studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Postoperative Mortality and Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiovascular Surgery: Insights From the Japanese Registry Data.",
  "title_text": "Postoperative Mortality and Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiovascular Surgery: Insights From the Japanese Registry Data.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T12:25:34Z",
  "url": "https://research.draconitic.com/paper/9ebxheyvy28s0",
  "venue": "Circulation reports",
  "versions": []
}