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Better preoperative exercise function is associated with shorter hospital stay after paediatric pulmonary valve
Naomi Gauthier1,2, Angelika Muter3, Jonathan Rhodes1,2
1Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Insights
Children with better exercise capacity undergoing pulmonary valve replacement surgery had shorter hospital stays. Optimizing exercise capacity before and after surgery may improve outcomes for pediatric patients with congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Exercise Physiology
Background:
- Exercise capacity is a modifiable factor influencing surgical outcomes in adults with congenital heart disease (CHD).
- The relationship between exercise capacity and surgical outcomes in pediatric patients undergoing pulmonary valve replacement (PVR) is not well-established.
Purpose of the Study:
- To explore the association between preoperative exercise capacity, specifically percent predicted peak oxygen consumption (ppVO2), and surgical outcomes in children undergoing PVR.
- To determine if higher preoperative ppVO2 correlates with a shorter total hospital length of stay (LOS).
Main Methods:
- Retrospective cohort study of 86 pediatric patients (aged 8-18 years) who underwent surgical PVR.
- Primary predictor: preoperative ppVO2. Primary outcome: total hospital LOS.
- Cox proportional hazards regression analysis was used to assess the association between ppVO2 and LOS.
Main Results:
- Patients with ppVO2 ≥ 70% (n=46) had a significantly shorter LOS (4.4 days) compared to those with ppVO2 < 70% (n=40, 5.4 days; p=0.007).
- Median ppVO2 increased over surgical eras, but LOS did not correlate with surgical era or ventricular function/dilation.
- Ninety patients had preoperative cardiopulmonary exercise tests within 6 months of surgery, with 86 included in the final analysis.
Conclusions:
- Improved preoperative exercise capacity in children undergoing PVR is associated with a shorter hospital LOS.
- Exercise capacity is a potentially modifiable factor that could be optimized pre- and post-PVR.
- Systematic cardiopulmonary exercise testing is needed to fully understand the impact of exercise capacity optimization.
Abstract:
Exercise capacity is a modifiable factor in patients with CHD that has been related to surgical outcomes in adults. We hypothesised that this was true for children undergoing surgical pulmonary valve replacement; therefore, the relationship of preoperative percent predicted peak oxygen consumption to surgical outcomes as measured by total hospital length of stay was explored.
Methods:
Single centre retrospective cohort study of patients aged 8-18 years who underwent surgical pulmonary valve replacement. The primary predictor was preoperative percent predicted peak oxygen consumption, and primary outcome was total hospital length of stay. Clinical, imaging, and cardiopulmonary exercise test data were reviewed and compared to total hospital length of stay. Cox proportional hazards regression was used to examine the association between total hospital length of stay and percent predicted peak oxygen consumption.
Results:
Three-hundred and seventy patients undergoing pulmonary valve replacement/conduit change between 2003 and 2017 at Boston Children's Hospital were identified. Ninety had preoperative cardiopulmonary exercise tests within 6 months of surgery. Exclusion for inadequate exercise data (n = 3) and imaging data (n = 1) left 86 patients for review. Patients with percent predicted peak oxygen consumption ≥ 70% (n = 46, 53%) had shorter total hospital length of stay (4.4 days) than the 40 with percent predicted peak oxygen consumption <70% (5.4 days, p = 0.007). Median percent predicted peak oxygen consumption increased over sequential surgical eras (p < 0.001), but total hospital length of stay did not correlate with surgical era, preoperative left ventricular function, or preoperative right ventricular dilation.
Conclusion:
Children undergoing surgical pulmonary valve replacement with better preoperative exercise capacity had shorter total hospital length of stay. Exercise capacity is a potentially modifiable factor prior to and after pulmonary valve replacement. Until more patients systematically undergo cardiopulmonary exercise tests, the full impact of optimisation of exercise capacity will not be known.
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