Key Takeaways & Executive Findings
- ā¢ā¢ ā¢ The overall prevalence of CHD was 8.2 per 1,000 live births, with VSD (32.4%) and ASD (28.7%) being the most common defects, underscoring the need for early screening and intervention in high-burden populations. ā¢ ā¢ Surgical repair was performed in 76.9% of patients, with an overall in-hospital mortality of 2.3%; however, mortality spiked to 5.8% in neonates and 18.2% in complex CHD, emphasizing the necessity for specialized neonatal cardiac care. ā¢ ā¢ Postoperative complications occurred in 18.5% of patients, with arrhythmias (6.2%) and residual shunts (4.1%) being the most frequent, highlighting the importance of meticulous surgical technique and postoperative monitoring. ā¢ ā¢ The median hospital stay was 12 days (IQR 8-18), indicating a substantial healthcare resource utilization; optimizing perioperative pathways could reduce costs and improve patient throughput.
Abstract
Congenital heart disease (CHD) remains a leading cause of infant morbidity and mortality worldwide. In China, the prevalence and clinical outcomes of CHD have not been comprehensively characterized in recent years. This multicenter cohort study aimed to delineate the epidemiological trends, clinical presentations, and surgical outcomes of CHD across diverse Chinese populations. We retrospectively analyzed data from 12,845 patients diagnosed with CHD between January 2015 and December 2020 at 15 tertiary referral centers. The overall prevalence of CHD was 8.2 per 1,000 live births, with a male-to-female ratio of 1.1:1. The most common defect was ventricular septal defect (VSD) (32.4%), followed by atrial septal defect (ASD) (28.7%) and patent ductus arteriosus (PDA) (15.3%). Surgical repair was performed in 9,876 patients (76.9%), with an overall in-hospital mortality of 2.3%. Mortality was significantly higher in neonates (5.8%) and in those with complex CHD (e.g., hypoplastic left heart syndrome, 18.2%). Postoperative complications occurred in 18.5% of patients, with arrhythmias (6.2%) and residual shunts (4.1%) being most frequent. The median hospital stay was 12 days (IQR 8-18). Our findings underscore the substantial burden of CHD in China and highlight the need for improved prenatal screening and risk-stratified management to reduce mortality, particularly in high-risk subgroups.
1. Introduction
Congenital heart disease (CHD) represents the most common birth defect globally, affecting approximately 1% of live births. In China, the burden of CHD has been historically underappreciated due to fragmented data and heterogeneous diagnostic criteria. Existing registries often lack comprehensive clinical granularity, limiting the ability to assess true prevalence, treatment outcomes, and regional disparities. This study addresses the critical gap by establishing a large, multicenter cohort that captures detailed epidemiological and clinical data across diverse Chinese populations.
The primary bottleneck in CHD management in China has been the lack of a unified, risk-stratified approach to surgical intervention, particularly for complex neonatal cases. Our protocol leverages a standardized data collection framework across 15 tertiary centers, enabling robust analysis of surgical outcomes and complication rates. By identifying high-risk subgroupsāsuch as neonates and those with complex lesionsāthis study provides actionable insights to guide clinical decision-making and resource allocation, ultimately aiming to reduce mortality and improve long-term outcomes.
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ZHANG Wei, LI Ming, WANG Fang, et al. (2025). Epidemiological and Clinical Characteristics of Congenital Heart Disease in China: A Multicenter Cohort Study. Chinese Journal of New Drugs. https://doi.org/pub_80__articleID_245
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Frequently Asked Questions
What is the overall prevalence of congenital heart disease in China, and how does it compare to global estimates?
Our study found a prevalence of 8.2 per 1,000 live births, which is consistent with global estimates (approximately 8-10 per 1,000). This suggests that CHD is a significant public health issue in China, warranting enhanced screening and early intervention programs.
What are the key risk factors for in-hospital mortality after surgical repair of CHD?
In-hospital mortality was significantly higher in neonates (5.8%) and in patients with complex CHD (e.g., hypoplastic left heart syndrome, 18.2%). These findings underscore the need for specialized neonatal cardiac care and risk-stratified surgical planning to improve outcomes in high-risk subgroups.
What are the most common postoperative complications, and how do they impact patient management?
The most common postoperative complications were arrhythmias (6.2%) and residual shunts (4.1%). These complications necessitate vigilant postoperative monitoring and may require additional interventions, potentially prolonging hospital stay and increasing healthcare costs.
How does the median hospital stay of 12 days compare to international benchmarks, and what are the implications for resource utilization?
The median hospital stay of 12 days is comparable to that in developed countries, but given the high volume of surgeries in China, this translates to substantial healthcare resource utilization. Optimizing perioperative care pathways and early discharge protocols could reduce costs and improve patient throughput.
What are the limitations of this study, and how might they affect the generalizability of the findings?
This study is retrospective and limited to tertiary referral centers, which may introduce selection bias and overrepresent severe cases. Additionally, the lack of long-term follow-up data restricts our ability to assess late outcomes. Future prospective studies with longer follow-up are needed to confirm these findings and inform policy.
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