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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Validation of the grown-ups with congenital heart disease score
Jürgen Hörer1, Régine Roussin1, Emanuel LeBret1
1Department of Pediatric Cardiology and Congenital Heart Disease, Hopital Marie Lannelongue, Université Paris-Sud, Le Plessis Robinson, France.
Insights
The GUCH mortality score accurately predicts postoperative mortality in adults undergoing congenital heart disease surgery. This validation confirms its utility for risk assessment in this complex patient group.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Outcomes Research
Background:
- Adults with congenital heart disease (ACHD) often have comorbidities and require complex cardiac surgery.
- Redo operations in ACHD patients increase risks of mortality and morbidity.
- Existing risk scores may not fully capture the complexities of ACHD surgery.
Purpose of the Study:
- To validate the predictive accuracy of the recently proposed Grown-ups with Congenital Heart Disease (GUCH) mortality and morbidity scores.
- To assess the performance of GUCH scores in a large, single-center cohort of adult patients undergoing congenital heart surgery.
Main Methods:
- Retrospective analysis of 824 consecutive adult congenital heart disease surgeries performed between 2005 and 2016.
- Definition of mortality (hospital or 30-day) and morbidity (specific complications including renal failure, neurologic deficit, AV block, circulatory support, phrenic nerve injury, reoperation).
- Assessment of GUCH score discriminatory power using the area under the receiver operating characteristics curve (c-index).
Main Results:
- The study evaluated 824 operations in adults with congenital heart disease.
- Hospital mortality was 3.4% and morbidity was 10.0%.
- The GUCH mortality score demonstrated strong predictive power (c-index = 0.809), while the GUCH morbidity score showed moderate predictive power (c-index = 0.676).
Conclusions:
- The GUCH mortality score is a reliable tool for predicting postoperative mortality in adults with congenital heart disease.
- Validation in a large cohort supports the use of GUCH scores for risk stratification in this population.
- Further evaluation of the GUCH morbidity score may be warranted.
Objectives:
Adults with congenital heart disease in need of heart surgery frequently present with significant comorbidity. Furthermore, additional technical difficulties often related to redo operations increase the risk for postoperative mortality and morbidity. Hence, next to the type of the procedure, additional procedure-dependent and procedure-independent factors have to be considered for risk evaluation. The recently proposed grown-ups with congenital heart disease (GUCH) mortality and morbidity scores account for these additional risk factors. We sought to validate their predictive power in a large population operated in a single centre.
Methods:
Data of all consecutive patients aged 18 years or more, who underwent surgery for congenital heart disease between 2005 and 2016, were collected. Mortality was defined as hospital mortality or mortality within 30 days following surgery. Morbidity was defined as occurrence of one or more of the following complications: renal failure requiring dialysis, neurologic deficit persisting at discharge, atrioventricular block requiring permanent pacemaker implantation, mechanical circulatory support, phrenic nerve injury and unplanned reoperation. The discriminatory power of the GUCH scores was assessed using the area under the receiver operating characteristics curve (c-index, including 95% CI).
Results:
Eight hundred and twenty-four operations were evaluated. Additional procedure-dependent and procedure-independent factors, as defined in the GUCH scores, were present in 165 patients (20.0%) and 544 patients (66.0%), respectively. Hospital mortality and morbidity was 3.4% and 10.0%, respectively. C-index for GUCH mortality score was 0.809 (0.742-0.877). C-index for GUCH morbidity score was 0.676 (0.619-0.734).
Conclusions:
We could confirm the good predictive power of the GUCH mortality score for postoperative mortality in a large population of adults with congenital heart disease.
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