TY - JOUR
T1 - Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease
AU - Pediatric Heart Network Investigators
AU - Nathan, Meena
AU - Levine, Jami C.
AU - Van Rompay, Maria I.
AU - Lambert, Linda M.
AU - Trachtenberg, Felicia L.
AU - Colan, Steven D.
AU - Adachi, Iki
AU - Anderson, Brett R.
AU - Bacha, Emile A.
AU - Eckhauser, Aaron
AU - Gaynor, J. William
AU - Graham, Eric M.
AU - Goot, Benjamin
AU - Jacobs, Jeffrey P.
AU - John, Rija
AU - Kaltman, Jonathan R.
AU - Kanter, Kirk R.
AU - Mery, Carlos M.
AU - LuAnn Minich, L.
AU - Ohye, Richard
AU - Overman, David
AU - Pizarro, Christian
AU - Raghuveer, Geetha
AU - Schamberger, Marcus S.
AU - Schwartz, Steven M.
AU - Narasimhan, Shanthi L.
AU - Taylor, Michael D.
AU - Wang, Ke
AU - Newburger, Jane W.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/5/18
Y1 - 2021/5/18
N2 - 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.
AB - 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.
KW - Residual Lesion Score
KW - days alive and out of the hospital
KW - outcomes
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U2 - 10.1016/j.jacc.2021.03.304
DO - 10.1016/j.jacc.2021.03.304
M3 - Article
C2 - 33985683
AN - SCOPUS:85105026207
SN - 0735-1097
VL - 77
SP - 2382
EP - 2394
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 19
ER -