Morbidity and Mortality in Adult Congenital Heart Surgery: Physiologic Component Augments Risk Prediction.

Area of Science:

• Cardiology
• Cardiac Surgery
• Congenital Heart Disease

Background:

• The 2018 American College of Cardiology/American Heart Association guidelines introduced the Anatomic and Physiologic Stratification System (ACAP) score.
• Evaluation of the ACAP score's efficacy in predicting outcomes after cardiac surgery for adult congenital heart disease (ACHD) is crucial.

Purpose of the Study:

• To assess if the ACAP score better estimates mortality and morbidity in ACHD patients undergoing cardiac operations.
• To compare the predictive performance of ACAP with existing risk stratification systems.

Main Methods:

• The ACAP score was calculated for 318 ACHD patients undergoing heart surgery (2001-2019).
• Primary endpoint was perioperative mortality; secondary endpoint was a composite of mortality, prolonged ventilation, and renal failure.
• Logistic regression and receiver operating characteristic curves were used to compare predictive abilities.

Main Results:

• The ACAP score, incorporating anatomic and physiologic components, achieved an area under the curve of 0.81 for perioperative mortality.
• Adding physiologic severity significantly improved the predictive ability of other scores (ACHS and STAT) for the composite outcome.
• The predictive power of ACAP was comparable to enhanced ACHS and STAT scores.

Conclusions:

• Physiologic severity significantly enhances the prediction of mortality and morbidity following cardiac surgery in ACHD patients.
• Current risk models require further development to be more robust and specific for ACHD populations.