Postoperative Mortality and Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiovascular Surgery: Insights From the Japanese Registry Data.
7 affiliations
- 1Department of Cardiology, Institute of Medicine, University of Tsukuba Ibaraki Japan.
- 2Laboratory of Mathematical Informatics in Medicine, Institute of Medicine, University of Tsukuba Ibaraki Japan.
- 3Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan.
- 4Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan.
- 5Department of Pediatrics, Institute of Medicine, University of Tsukuba Ibaraki Japan.
- 6Department of Cardiology, Fukuoka Children's Hospital Fukuoka Japan.
- 7Department of Cardiovascular Surgery, Institute of Medicine, University of Tsukuba Ibaraki Japan.
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.
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BibTeX
@article{osawa2026postoperative,
title = {{Postoperative Mortality and Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiovascular Surgery: Insights From the Japanese Registry Data.}},
author = {Takumi Osawa and Tomoko Machino-Ohtsuka and Keitaro Kume and Takahiro Yano and Mike Saji and Koshiro Kanaoka and Yoko Sumita and Yusuke Yano and Ruriko Numata and Naoto Kawamatsu and Ayako Kuraoka and Hideyuki Kato and Yuji Hiramatsu and Tomoko Ishizu},
journal = {Circulation reports},
year = {2026},
month = oct,
doi = {10.1253/circrep.cr-26-0064},
url = {https://europepmc.org/article/MED/43010985},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Postoperative Mortality and Risk Factors in Adults With Congenital Heart Disease Undergoing Cardiovascular Surgery: Insights From the Japanese Registry Data.
AU - Takumi Osawa
AU - Tomoko Machino-Ohtsuka
AU - Keitaro Kume
AU - Takahiro Yano
AU - Mike Saji
AU - Koshiro Kanaoka
AU - Yoko Sumita
AU - Yusuke Yano
AU - Ruriko Numata
AU - Naoto Kawamatsu
AU - Ayako Kuraoka
AU - Hideyuki Kato
AU - Yuji Hiramatsu
AU - Tomoko Ishizu
PY - 2026
DA - 2026/10/10
JO - Circulation reports
DO - 10.1253/circrep.cr-26-0064
UR - https://europepmc.org/article/MED/43010985
AB - 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.
SN - 2434-0790
ER -