Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease.
Document Type
Article
Publication Date
5-18-2021
Identifier
DOI: 10.1016/j.jacc.2021.03.304
Abstract
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.
Journal Title
Journal of the American College of Cardiology
Volume
77
Issue
19
First Page
2382
Last Page
2394
Keywords
Residual Lesion Score; days alive and out of the hospital; outcomes
Recommended Citation
Nathan M, Levine JC, Van Rompay MI, et al. Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease. J Am Coll Cardiol. 2021;77(19):2382-2394. doi:10.1016/j.jacc.2021.03.304
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