SPC365

Old Age in Adult Congenital Heart Disease: a contemporary reality

Session: Posters (Sessão 3 - Écran 1) - Cardiopatias Congénitas no Adulto
Speaker: Tânia Proença

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.6 Congenital Heart Disease – Clinical
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Tânia Proença; Miguel Martins Carvalho; Ricardo Alves Pinto; Filipa Amador; Catarina Costa; João Calvão; Catarina Marques; André Cabrita; Cátia Priscila; Ana Pinho; Luís Santos; Maria Crisitina Cruz; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">: Congenital Heart Disease (CHD) affects under 1% of newborns and albeit once associated with bad prognosis, nowadays a remarkable increase in their survival was reached. Lifelong surveillance is essential, bringing new challenges as patients getting older.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Purpose</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">: To observe a group of old patients followed in an Adult CHD <span style="color:black">(ACHD) </span>outpatients clinic, </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">access their comorbidities, cardiac interventions, complications and clinical outcomes. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">: We retrospectively analysed a group of old-patients (&gt; 60 year-old) evaluated during the past year in an ACHD outpatient clinic. </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Clinical features were collected and time-to-event statistics were analyzed. Major adverse event (AE) was defined as a composite of all-cause death, cardiac re-intervention, ischemic stroke (IS) and acute coronary syndrome (ACS). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">: A total of 54 patients were included, 69% female with a median age of 68 (61-82) year-old. Most frequent diagnosis were atrial septal defect (ASD, 39%), Tetralogy of Fallot (13%), Ebstein anomaly (11%), and atrioventricular (AV) septal defect (11%). The majority of patients (77%) were submitted to intervention, with a median age of 35 years; 29% had a second intervention during lifetime, about 23 years after first intervention. Concerning clinical data, almost all patients were in NYHA class I or II, only 4% had oxygen saturation under 90%, 26% had pulmonary hypertension and 13% chronic kidney disease. Regarding cardiac function, most had normal systolic function (systemic and subpulmonic ventricular dysfunction was present in 7% of patients). The most frequent dysfunctional valve was subpulmonic AV valve, with 20% presenting moderate to severe regurgitation. </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">During follow-up, 41% remained in sinus rhythm, most with normal AV conduction. 59% of patients developed atrial flutter or fibrillation (AF/AFL), 15% implanted definitive pacemaker and none ICD or CRT was implanted. In time-to-arrhythmia analysis more than 95% and 60% kept outcome-free at 40 and 60 year-old, respectively, but all patients developed arrythmia before complete 80 years. During follow-up, 6% had IS and 2% ACS; time-to-AE analysis showed that 80% were event-free at 60 year-old and even at 80 years almost 50% of patients had no AE. Regarding gender and demographic features, there were no differences comparing patients living in urban versus rural neighbourhoods and female versus male (Log Rank, p=0.205 and p=0.156). Concerning female patients, 19% had a successful pregnancy. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusion</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">: In a cohort of ACHD older than 60 years, the most frequent diagnosis was ASD; most of them had normal systolic function and non-significative valvular disfunction.&nbsp; Most patients remained free of events until 40 years and a significant portion of patients had no AE during lifetime. AF/AFL were the most frequent complication, generally emerged after 40 years and was always present at 80 year-old. </span></span></span></p>