Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease. J Am Coll Cardiol 2021 May 18;77(19):2382-2394
Date
05/15/2021Pubmed ID
33985683Pubmed Central ID
PMC8245007DOI
10.1016/j.jacc.2021.03.304Scopus ID
2-s2.0-85105026207 (requires institutional sign-in at Scopus site) 34 CitationsAbstract
BACKGROUND: Many factors affect outcomes after congenital cardiac surgery.
OBJECTIVES: The RLS (Residual Lesion Score) study explored the impact of severity of residual lesions on post-operative outcomes across operations of varying complexity.
METHODS: In a prospective, multicenter, observational study, 17 sites enrolled 1,149 infants undergoing 5 common operations: tetralogy of Fallot repair (n = 250), complete atrioventricular septal defect repair (n = 249), arterial switch operation (n = 251), coarctation or interrupted arch with ventricular septal defect (VSD) repair (n = 150), and Norwood operation (n = 249). The RLS was assigned based on post-operative echocardiography and clinical events: RLS 1 (trivial or no residual lesions), RLS 2 (minor residual lesions), or RLS 3 (reintervention for or major residual lesions before discharge). The primary outcome was days alive and out of hospital within 30 post-operative days (60 for Norwood). Secondary outcomes assessed post-operative course, including major medical events and days in hospital.
RESULTS: RLS 3 (vs. RLS 1) was an independent risk factor for fewer days alive and out of hospital (p ≤ 0.008) and longer post-operative hospital stay (p ≤ 0.02) for all 5 operations, and for all secondary outcomes after coarctation or interrupted arch with VSD repair and Norwood (p ≤ 0.03). Outcomes for RLS 1 versus 2 did not differ consistently. RLS alone explained 5% (tetralogy of Fallot repair) to 20% (Norwood) of variation in the primary outcome.
CONCLUSIONS: Adjusting for pre-operative factors, residual lesions after congenital cardiac surgery impacted in-hospital outcomes across operative complexity with greatest impact following complex operations. Minor residual lesions had minimal impact. These findings may provide guidance for surgeons when considering short-term risks and benefits of returning to bypass to repair residual lesions.
Author List
Nathan M, Levine JC, Van Rompay MI, Lambert LM, Trachtenberg FL, Colan SD, Adachi I, Anderson BR, Bacha EA, Eckhauser A, Gaynor JW, Graham EM, Goot B, Jacobs JP, John R, Kaltman JR, Kanter KR, Mery CM, LuAnn Minich L, Ohye R, Overman D, Pizarro C, Raghuveer G, Schamberger MS, Schwartz SM, Narasimhan SL, Taylor MD, Wang K, Newburger JW, Pediatric Heart Network InvestigatorsAuthor
Ben Goot MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Cardiac Surgical ProceduresEchocardiography
Female
Follow-Up Studies
Heart Defects, Congenital
Humans
Incidence
Infant
Infant, Newborn
Male
Postoperative Complications
Prospective Studies
Risk Factors
Survival Rate
Treatment Outcome
United States