Long-Term Outcomes of Patients Requiring Unplanned Repeated Interventions After Surgery for Congenital Heart Disease

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

doi:10.1016/j.jacc.2022.04.027

Cited by 11 publications

(3 citation statements)

References 32 publications

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“…Procedural‐risk factors included ascending aortic diameter <2 mm, at least moderate left or right atrioventricular valve regurgitation, aortic atresia, and intact or restrictive atrial septum or obstructed pulmonary venous return (OPVR). 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.…”

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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“…Patients requiring PVR for sequelae of congenital pulmonary valve disease or RVOT obstruction constitute a challenging population given the need for reoperative surgery and lack of a dedicated bioprosthesis for the pulmonic position. 12 This is of particular relevance given the growing population of patients with adult congenital heart disease. 13 Although aortic bioprostheses are most commonly used for PVR, the limited durability of currently available valves continues to plague outcomes.…”

Section: Commentmentioning

confidence: 99%

Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis

Sengupta,

Pastuszko,

Zaidi

et al. 2023

World J Pediatr Congenit Heart Surg

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Background Controversy regarding the optimal pulmonary valve substitute remains, with no approved surgical valve for pulmonary valve replacement (PVR). Furthermore, unfavorable anatomy often precludes transcatheter PVR in patients with congenital heart disease. We therefore sought to evaluate the feasibility of the Edwards Inspiris pericardial aortic bioprosthesis in the pulmonary position in pediatric and adult patients requiring PVR. Methods Data from consecutive patients who underwent PVR from February 2019 to February 2021 at our institution were retrospectively reviewed. Postoperative adverse events included paravalvular or transvalvular leak, endocarditis, explant, thromboembolism, valve thrombosis, valve-related bleeding, hemolysis, and structural valve degeneration. Progression of valve gradients was assessed from discharge to 30 days and one year. Results Of 24 patients with median age of 26 years (interquartile range [IQR]: 17-33; range: 4-60 years), 22 (91.7%) patients had previously undergone tetralogy of Fallot repair and 2 (8.3%) patients had undergone double-outlet right ventricle repair in the neonatal period or infancy. All patients had at least mild right ventricular (RV) dilatation (median RV end-diastolic volume index 161.4, IQR: 152.3-183.5 mL/m2) and at least moderate pulmonary insufficiency (95.8%) or stenosis (8.3%). Median cardiopulmonary bypass and cross-clamp times were 71 (IQR: 63-101) min and 66 (IQR: 60-114) min, respectively. At a median postoperative follow-up of 2.5 years (IQR: 1.4-2.6; range: 1.0-3.0 years), there were no mortalities, valve-related reoperations, or adverse events. Postoperative valve gradients and the severity of pulmonary regurgitation did not change significantly over time. Conclusions At short-term follow-up, the bioprosthesis in this study demonstrated excellent safety and effectiveness for PVR. Further studies with longer follow-up are warranted.

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“…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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Long-Term Outcomes of Patients Requiring Unplanned Repeated Interventions After Surgery for Congenital Heart Disease

Cited by 11 publications

References 32 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

Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis

Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery

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