Outcomes in structural heart disease in New South Wales, Australia: From paediatrics to pregnancy

Abstract

Aim To characterise and explore the contemporary outcomes at key points in the life of individuals in New South Wales (NSW), Australia, who have undergone a procedure for structural heart disease. Methods The population with structural heart disease was identified and outcomes at key points in life were evaluated using different methodologies; record linkage, retrospective cohort study and systematic review. Health and education outcomes of children with structural heart disease were evaluated via population-based record-linkage cohort studies. The role of advanced imaging methods in managing structural heart disease in paediatrics was evaluated via literature review. A retrospective cohort study was used to evaluate individuals who had undergone a percutaneous pulmonary valve implantation for structural heart disease. Health outcomes of women (and their offspring) who had undergone a prosthetic heart valve placement prior to pregnancy were evaluated using population-based record-linkage studies, systematic review and meta-analysis Results The main findings of this thesis include: -Structural heart disease in NSW requiring procedural management in the first year of life affects 2.5 per 1 000 births. Immediate health outcomes such as length of stay and mortality are similar to other centers. -Children who have had a cardiac procedure demonstrate a greater incidence of poor education outcome. Sociodemographic risk factors and ongoing health status are the major predictors of educational outcomes. -Novel imaging strategies can aid diagnosis, monitoring and management in complex structural heart disease. -Percutaneous pulmonary valve implantation, for rehabilitation of the right ventricular outflow tract in structural heart disease, has a low risk of a serious adverse event and shorter length of stay than historical surgical options. -The risk of severe maternal morbidity, a cardiovascular event, preterm birth and small-for-gestation age infants remains higher for women with a heart valve prosthesis than a pregnancy in the general population. Conclusions From early childhood to adult life, including child bearing years, individuals who have undergone a cardiac procedure for structural heart disease remain at risk of altered health status. This includes additional hospitalisations, maternal morbidity as well as adverse developmental and educational outcomes compared to the general population. Contemporary data demonstrates improvements in some domains. Evolution in multi-disciplinary, life-long care provides hope for further ameliorating outcomes.