Comparison of Intraoperative and Discharge Residual Lesion Severity in Congenital Heart Surgery

Sengupta, Aditya; Kohlsaat, Katherine; Colan, Steven D.; Nido, Pedro J. del; Nathan, Meena

doi:10.1016/j.athoracsur.2022.02.081

Cited by 14 publications

(4 citation statements)

References 20 publications

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“…Residual lesion severity was assessed using the Residual Lesion Score 17 , 18 or its previous iteration, the Technical Performance Score (TPS). 19 , 20 Scores were assigned both intraoperatively (per the postcardiopulmonary bypass or postrepair echocardiogram) 21 and before discharge (per the predischarge echocardiogram or need for an unplanned reintervention before discharge from the index hospitalization), 22 based on residual lesions in the following subcomponent areas of the Norwood operation: proximal and distal aortic arch, coronary arteries or Stansel anastomosis, atrial septum, neo‐aortic valve, modified Blalock‐Taussig shunt or right ventricle‐pulmonary artery conduit, and branch pulmonary arteries. 23 , 24 Briefly, patients were categorized as Class 1 (no or trivial residua), Class 2 (minor residua), or Class 3 (major residua or need for an unplanned predischarge reintervention).…”

Section: Methodsmentioning

confidence: 99%

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Sengupta

Bucholz

Schroeder

et al. 2023

JAHA

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Background The impact of neighborhood socioeconomic status (SES) on outcomes following first‐stage palliation of single ventricle heart disease remains incompletely characterized. Methods and Results This was a single‐center, retrospective review of consecutive patients who underwent the Norwood procedure from January 1, 1997 to November 11, 2017. Outcomes of interest included in‐hospital (early) mortality or transplant, postoperative hospital length‐of‐stay, inpatient cost, and postdischarge (late) mortality or transplant. The primary exposure was neighborhood SES, assessed using a composite score derived from 6 US census‐block group measures related to wealth, income, education, and occupation. Associations between SES and outcomes were assessed using logistic regression, generalized linear, or Cox proportional hazards models, adjusting for baseline patient‐related risk factors. Of 478 patients, there were 62 (13.0%) early deaths or transplants. Among 416 transplant‐free survivors at hospital discharge, median postoperative hospital length‐of‐stay and cost were 24 (interquartile range, 15–43) days and $295 000 (interquartile range, $193 000–$563 000), respectively. There were 97 (23.3%) late deaths or transplants. On multivariable analysis, patients in the lowest SES tertile had greater risk of early mortality or transplant (odds ratio [OR], 4.3 [95% CI, 2.0–9.4; P <0.001]), had longer hospitalizations (coefficient 0.4 [95% CI, 0.2–0.5; P <0.001]), incurred higher costs (coefficient 0.5 [95% CI, 0.3–0.7; P <0.001]), and had greater risk of late mortality or transplant (hazard ratio, 2.2 [95% CI, 1.3–3.7; P =0.004]), compared with those in the highest tertile. The risk of late mortality was partially attenuated with successful completion of home monitoring programs. Conclusions Lower neighborhood SES is associated with worse transplant‐free survival following the Norwood operation. This risk persists throughout the first decade of life and may be mitigated with successful completion of interstage surveillance programs.

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Section: Methodsmentioning

confidence: 99%

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Sengupta

Bucholz

Schroeder

et al. 2023

JAHA

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“…The full multivariable model included the intraoperative Residual Lesion Score (or Technical Performance Score), an independent and important predictor of in-hospital outcomes after congenital cardiac surgery. 21,22 In fact, on adjusting for child opportunity, children with major intraoperative residua had ≈6× the risk of early death or transplant, compared with those with no residua. Taken together, our findings suggest that early mortality or transplant after surgery for congenital heart disease may be more aptly predicted by anatomic and physiologic substrates of individual diagnoses and operations rather than by differences in child opportunity.…”

Section: Discussionmentioning

confidence: 99%

“…Residual lesion severity was assessed using the Residual Lesion Score or its previous iteration, the Technical Performance Score, a strong and significant predictor of adverse postoperative outcomes after a variety of congenital heart operations. [21][22][23] Scores were assigned both intraoperatively (based on the post-cardiopulmonary bypass or postrepair echocardiogram) and before discharge (based on the predischarge echocardiogram or need for an unplanned reintervention before discharge from the index hospitalization), as previously described. 24,25 Briefly, patients were categorized as Class 1 (no or trivial residua), Class 2 (minor residua), or Class 3 (major residua or need for an unplanned predischarge reintervention for residual lesions).…”

Section: Outcomes Predictors and Covariatesmentioning

confidence: 99%

Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery

et al. 2022

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Background: While singular measures of socioeconomic status have been associated with outcomes after surgery for congenital heart disease, the multifaceted pathways through which a child’s environment impacts similar outcomes remain incompletely characterized. We sought to evaluate the association between childhood opportunity level and adverse outcomes after congenital heart surgery. Methods: Data from patients undergoing congenital cardiac surgery from January 2011 to January 2020 at a quaternary referral center were retrospectively reviewed. Outcomes of interest included predischarge (early) mortality or transplant, postoperative hospital length-of-stay, inpatient cost of hospitalization, postdischarge (late) mortality or transplant, and late unplanned reintervention. The primary predictor was a US census tract–based, nationally-normed composite metric of contemporary child neighborhood opportunity comprising 29 indicators across 3 domains (education, health and environment, and socioeconomic), categorized as very low, low, moderate, high, and very high. Associations between childhood opportunity level and outcomes were evaluated using logistic regression (early mortality), generalized linear (length-of-stay and cost), Cox proportional hazards (late mortality), or competing risk (late reintervention) models, adjusting for baseline patient-related factors, case complexity, and residual lesion severity. Results: Of 6133 patients meeting entry criteria, the median age was 2.0 years (interquartile range, 3.6 months–8.3 years). There were 124 (2.0%) early deaths or transplants, the median postoperative length-of-stay was 7 days (interquartile range, 5–13 days), and the median inpatient cost was $76 000 (interquartile range, $50 000–130 000). No significant association between childhood opportunity level and early mortality or transplant was observed ( P =0.21). On multivariable analysis, children with very low and low opportunity had significantly longer length-of-stay and incurred higher costs compared with those with very high opportunity (all P <0.05). Of 6009 transplant-free survivors of hospital discharge, there were 175 (2.9%) late deaths or transplants, and 1008 (16.8%) reinterventions at up to 10.5 years of follow-up. Patients with very low opportunity had a significantly greater adjusted risk of late death or transplant (hazard ratio, 1.7 [95% CI, 1.1–2.6]; P =0.030) and reintervention (subdistribution hazard ratio, 1.9 [95% CI, 1.5–2.3]; P <0.001), versus those with very high opportunity. Conclusions: Childhood opportunity level is independently associated with adverse outcomes after congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.

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“…Intraoperative covariates included total CPB time, aortic cross-clamp time, circulatory arrest time, and adequacy of repair as measured by intraoperative and postoperative Technical Performance Score (TPS) [22].…”

Section: Outcomes Primary Predictors and Covariatesmentioning

confidence: 99%

Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass

Kohlsaat,

Gauvreau,

Fynn-Thompson

et al. 2023

J Extra Corpor Technol

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Background: A standard blood prime for cardiopulmonary bypass (CPB) in congenital cardiac surgery may possess non-physiologic values for electrolytes, glucose, and lactate. Pre-bypass Ultrafiltration (PBUF) can make these values more physiologic and standardized prior to bypass initiation. We aimed to determine if using PBUF on blood primes including packed red blood cells and thawed plasma would make prime values more predictable and physiologic. Additionally, we aimed to evaluate whether the addition of PBUF had an impact on outcome measures. Methods: Retrospective review of consecutive patients ≤ 1 year of age undergoing an index cardiac operation on CPB between 8/2017-9/2021. As PBUF was performed at the perfusionists’ discretion, a natural grouping of patients that received PBUF vs. those that did not occurred. Differences in electrolytes, glucose, and lactate were compared at specific time-points using Fisher’s exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Clinical outcomes were also assessed. Results: In both cohorts, the median age at surgery was 3 months and 47% of patients were female; 308/704 (44%) of PBUF group and 163/414 (39%) of the standard prime group had at least one preoperative risk factor. The proportion of PBUF circuits which demonstrated more physiologic values for glucose (318 [45%]), sodium (434, [62%]), potassium (688 [98%]), lactate (612 [87%]) and osmolality (595 [92%]) was significantly higher when compared to standard prime circuit levels for glucose (8 [2%]), sodium (13 [3%], potassium (150 [36%]), lactate (56 [13%]) and osmolality (23 [6%]) prior to CPB initiation. There were no differences in clinical outcomes or rates of major adverse events between the two cohorts. Conclusions: PBUF creates standardized and more physiologic values for electrolytes, glucose, and lactate before the initiation of bypass without significant impacts on in-hospital outcomes.

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Comparison of Intraoperative and Discharge Residual Lesion Severity in Congenital Heart Surgery

Cited by 14 publications

References 20 publications

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Impact of Neighborhood Socioeconomic Status on Outcomes Following First‐Stage Palliation of Single Ventricle Heart Disease

Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery

Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass

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