Psychological adjustment and quality of life in children and adolescents following open-heart surgery for congenital heart disease: a systematic review

BMC Pediatr. 2009 Jan 22;9:6. doi: 10.1186/1471-2431-9-6.


Background: Children with congenital heart defects (CHD) requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their long-term psychological adjustment (PA) and health-related quality of life (QoL). Thus, we conducted a systematic review to determine the current knowledge on long-term outcome in this population.

Methods: We included randomized controlled trials, case control, or cohort studies published between 1990-2008 evaluating self- and proxy-reported PA and QoL in patients aged between two and 17 years with a follow-up of at least two years after open heart surgery for CHD.

Results: Twenty-three studies assessing psychological parameters and 12 studies assessing QoL were included. Methodological quality of the studies varied greatly with most studies showing a moderate quality. Results were as follows: (a) A considerable proportion of children experienced psychological maladjustment according to their parents; (b) studies on self-reported PA indicate a good outcome; (c) the studies on QoL suggest an impaired QoL for some children in particular for those with more severe cardiac disease; (d) parental reports of psychological maladjustment were related to severity of CHD and developmental delay.

Conclusion: A significant proportion of survivors of open-heart surgery for CHD are at risk for psychological maladjustment and impaired QoL. Future research needs to focus on self-reports, QoL data and adolescents.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Cardiac Surgical Procedures / psychology*
  • Child
  • Child, Preschool
  • Heart Defects, Congenital / psychology*
  • Heart Defects, Congenital / surgery*
  • Humans
  • Quality of Life*
  • Time Factors
  • Treatment Outcome