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Cardiopulmonary Exercise Testing for Surgical Risk Stratification in Adults with Congenital Heart Disease
Trevor Birkey1, Jennifer Dixon2, Roni Jacobsen3
1Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Cardiopulmonary exercise testing (CPET) shows potential for assessing risks in adult congenital heart disease (ACHD) patients undergoing cardiothoracic surgery. Certain CPET metrics correlated with prolonged recovery, suggesting its utility in predicting surgical outcomes.
Area of Science:
- Cardiology
- Cardiothoracic Surgery
- Exercise Physiology
Background:
- Adult congenital heart disease (ACHD) patients frequently need repeat cardiothoracic surgery, facing high morbidity and mortality risks.
- Existing pre-operative risk assessment tools for ACHD patients undergoing cardiac surgery are limited.
- Cardiopulmonary exercise testing (CPET) is established for predicting outcomes in non-cardiac surgery but its role in ACHD is unevaluated.
Purpose of the Study:
- To evaluate the utility of pre-operative cardiopulmonary exercise testing (CPET) for risk stratification in adult congenital heart disease (ACHD) patients undergoing major cardiothoracic surgery.
- To identify correlations between CPET parameters and post-operative outcomes such as length of stay and intubation duration.
Main Methods:
- Retrospective chart review of 75 ACHD patients who underwent CPET within 12 months before major cardiothoracic surgery.
- Exclusion of minimally invasive procedures, cardiomyopathy, acquired heart disease, single ventricle physiology, and heart transplant recipients.
- Collection of demographic data, CPET results (e.g., VE/VCO2 slope, peak HR, exercise time, peak VO2), and peri-operative surgical outcomes.
Main Results:
- A higher VE/VCO2 slope on CPET correlated with a prolonged post-operative length of stay (P=0.007).
- Decreased peak heart rate (HR), exercise time, heart rate response, and relative peak oxygen consumption were associated with prolonged intubation times (P<0.05 for all).
- Post-operative complications occurred in 59% of patients, with trends observed between exercise capacity and complications, though not statistically significant.
Conclusions:
- Pre-operative CPET parameters show potential correlations with specific post-operative outcomes like prolonged length of stay and intubation duration in ACHD patients.
- While trends suggest a link between exercise capacity and complications, further research is needed to establish statistical significance.
- CPET may offer valuable insights for risk assessment in ACHD patients undergoing cardiothoracic surgery, warranting further investigation.
Abstract:
Adult congenital heart disease (ACHD) patients often require repeat cardiothoracic surgery, which may result in significant morbidity and mortality. Currently, there are few pre-operative risk assessment tools available. In the general adult population, pre-operative cardiopulmonary exercise testing (CPET) has a predictive value for post-operative morbidity and mortality following major non-cardiac surgery. The utility of CPET for risk assessment in ACHD patients requiring cardiothoracic surgery has not been evaluated. Retrospective chart review was conducted on 75 ACHD patients who underwent CPET less than 12 months prior to major cardiothoracic surgery at Children's Hospital of Wisconsin. Minimally invasive procedures, cardiomyopathy, acquired heart disease, single ventricle physiology, and heart transplant patients were excluded. Demographic information, CPET results, and peri-operative surgical data were collected. The study population was 56% male with a median age of 25 years (17-58). Prolonged post-operative length of stay correlated with increased ventilatory efficiency slope (VE/[Formula: see text] slope) (P = 0.007). Prolonged intubation time correlated with decreased peak HR (P = 0.008), decreased exercise time (P = 0.002), decreased heart rate response (P = 0.008) and decreased relative peak oxygen consumption (P = 0.034). Post-operative complications were documented in 59% of patients. While trends were noted between post-operative complications and some measurements of exercise capacity, none met statistical significance. Future studies may further define the relationship between exercise capacity and post-operative morbidity in ACHD patients.
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