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Long-Term Outcomes of Patients Requiring Unplanned Repeated Interventions After Surgery for Congenital Heart Disease
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2022-06-20 , DOI: 10.1016/j.jacc.2022.04.027
Aditya Sengupta 1 , Kimberlee Gauvreau 2 , Katherine Kohlsaat 1 , Steven D Colan 3 , Jane W Newburger 3 , Pedro J Del Nido 4 , Meena Nathan 4
Affiliation  

Background

Unplanned catheter-based or surgical reinterventions after congenital heart operations are independently associated with operative mortality and increased postoperative length of stay.

Objectives

This study assessed the long-term outcomes of transplant-free survivors of hospital discharge requiring predischarge reinterventions after congenital cardiac surgery.

Methods

Data from patients who required predischarge reinterventions in the anatomic area of repair after congenital cardiac surgery and survived to hospital discharge at a quaternary referral center from January 2011 to December 2019 were retrospectively reviewed. Previously published echocardiographic criteria were used to assess the severity of persistent residual lesions at discharge (Grade 1, no residua; Grade 2, minor residua; and Grade 3, major residua). Outcomes included postdischarge (late) mortality or transplant and unplanned reintervention. Associations between predischarge residual lesion severity and outcomes were assessed by using Cox or competing risk models, adjusting for baseline patient characteristics, case complexity, and preoperative risk factors.

Results

Among the 408 patients who met entry criteria, there were 58 (14.2%) postdischarge deaths or transplants and 208 (51.0%) late reinterventions at a median follow-up of 3.0 years (IQR: 1.1-6.8 years). Greater predischarge residual lesion severity was associated with worse transplant-free survival and freedom from reintervention (both, P < 0.05). On multivariable analyses, Grade 3 patients had an increased risk of postdischarge mortality or transplant (HR: 4.8; 95% CI: 2.0-11; P < 0.001) and late reintervention (subdistribution HR: 2.1; 95% CI: 1.4-3.1; P < 0.001) vs Grade 1 patients.

Conclusions

Among transplant-free survivors requiring predischarge reinterventions after congenital cardiac surgery, those with persistent major residua have significantly worse long-term outcomes. These high-risk patients warrant closer surveillance.



中文翻译:

先天性心脏病手术后需要计划外重复干预的患者的长期结果

背景

先天性心脏手术后计划外的基于导管或外科手术的再干预与手术死亡率和术后住院时间延长独立相关。

目标

本研究评估了先天性心脏手术后需要出院前再次干预的出院无移植幸存者的长期结果。

方法

回顾性分析了 2011 年 1 月至 2019 年 12 月在四级转诊中心生存至出院的先天性心脏手术后需要在解剖区域修复的解剖区域进行出院前再干预的患者的数据。以前公布的超声心动图标准用于评估出院时持续残留病变的严重程度(1 级,无残留;2 级,轻微残留;3 级,主要残留)。结果包括出院后(晚期)死亡率或移植和计划外再干预。通过使用 Cox 或竞争风险模型,调整基线患者特征、病例复杂性和术前风险因素,评估出院前残留病变严重程度与结果之间的关联。

结果

在符合入组标准的 408 名患者中,中位随访 3.0 年(IQR:1.1-6.8 年)有 58 名(14.2%)出院后死亡或移植,208 名(51.0%)晚期再干预。更大的出院前残留病变严重程度与更差的无移植生存率和免于再干预相关(两者,P  < 0.05)。在多变量分析中,3 级患者出院后死亡或移植的风险增加(HR:4.8;95% CI:2.0-11;P  < 0.001)和晚期再干预(子分布 HR:2.1;95% CI:1.4-3.1;P  < 0.001) 与 1 级患者。

结论

在先天性心脏手术后需要出院前再次干预的无移植幸存者中,存在持续主要残留物的患者的长期预后明显较差。这些高危患者需要更密切的监测。

更新日期:2022-06-21
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