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Published on: December 11, 2017
Reoperations in adults with congenital heart disease: analysis of early outcome
Pascal A Berdat1, Franz Immer, Jean-Pierre Pfammatter
1University Hospital, Clinic for Cardiovascular Surgery, 3010 Bern, Switzerland. pascal.berdat@insel.ch
Insights
Reoperations in adults with congenital heart disease (GUCH) carry significant risks. Identifying preoperative and perioperative factors is crucial for improving outcomes in these complex patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Adult Congenital Heart Disease
Background:
- Adults with congenital heart disease (GUCH) represent a growing patient population.
- Many GUCH patients require reoperations due to late complications, residual defects, or further palliation.
Purpose of the Study:
- To identify perioperative risk factors associated with mortality and morbidity in GUCH patients undergoing reoperation.
Main Methods:
- Retrospective analysis of 66 consecutive GUCH patients undergoing reoperation between July 1987 and December 2000.
- Analysis included preoperative diagnoses, surgical procedures, and perioperative outcomes.
Main Results:
- Early mortality was 7.6%, with 24% experiencing serious postoperative complications.
- Preoperative risk factors included cyanosis, heart failure, VSD, TGA, pulmonary atresia, and prior palliative surgery.
- Perioperative risk factors for fatal outcomes included prolonged operation/bypass times, hypothermia, low output syndrome, and complications like renal failure and stroke.
Conclusions:
- Reoperations in GUCH patients are frequently for outflow tract lesions, coarctations, and Tetralogy of Fallot (TOF).
- Significant perioperative risks persist, particularly in patients with cyanosis, TGA, pulmonary atresia, and impaired ventricular function.
- Close follow-up, timely referral, and meticulous perioperative management are essential to mitigate risks and enhance outcomes.
Background:
Grown-ups with congenital heart disease (GUCH) are an increasingly important group of patients, with many requiring reoperations because of late complications or residual defects, correction after palliation, further palliation or heart transplantation.
Methods:
In order to identify perioperative risk factors, we have retrospectively analysed perioperative mortality and morbidity of 66 consecutive GUCH patients needing reoperations between July 1987 and December 2000 with a mean age of 28+/-12 (14.2-63.5) years and preoperative ejection fraction of 57+/-21%. Primary cardiac defects were LVOT pathology (17 patients), coarctation (10), Tetralogy of Fallot (TOF) (9), VSD (9), transposition of the great arteries (TGA) (7), Marfan syndrome (6), ASD (5) and others (3).
Results:
Reoperations included various aortic valve procedures (28), aortic replacements (16), ASD/VSD closures (16), conduits (11), RVOT procedures (8), coarctation repair (5), cardiac transplantation (3) or others (8). Early mortality was 7.6%. Serious postoperative complications occurred in 24%. Presence of cyanosis, heart failure, VSD, TGA, pulmonary atresia, correction after palliative surgery and number of previous operations were preoperative risk factors and duration of operation, cardiopulmonary bypass and aortic cross-clamp, core temperature, low output syndrome, use of epinephrine, pneumonia and ARDS, renal failure, dialysis and stroke perioperative risk factors for fatal outcome.
Conclusions:
Reoperations in GUCH patients are mostly due to outflow tract lesions, coarctations and TOF. Perioperative risks remain important especially with cyanosis, TGA, pulmonary atresia and poor ventricular function. Therefore, close follow-up, timely referral for re-intervention and adequate perioperative management are mandatory to reduce perioperative risks and improve results.
