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Risk of Cardiac Reoperation: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database
Elaine M Griffeth1, Elizabeth H Stephens1, Luke J Burchill2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Reoperative cardiac surgery for congenital heart disease increases mortality risk with each prior cardiopulmonary bypass operation. Three or more bypasses independently elevate operative mortality and morbidity, highlighting a critical challenge in reoperative cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Reoperative cardiac surgery for congenital heart disease (CHD) is increasing.
- Managing these complex cases presents significant challenges.
- Prior cardiopulmonary bypass (CPB) operations are a key factor in reoperative outcomes.
Purpose of the Study:
- To evaluate the association between the number of previous CPB operations and operative mortality and morbidity.
- To identify risk factors in patients undergoing reoperative cardiac surgery for CHD.
Main Methods:
- Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) from 2016-2021.
- Exclusion of infants and patients with univentricular physiology.
- Multivariable logistic regression adjusting for established risk models and institutional volume.
Main Results:
- Of 50,625 operations, 44% involved patients with prior CPB.
- Operative mortality significantly increased with the number of prior CPB operations (P < .001).
- Three or more prior CPB operations were associated with higher operative mortality (OR, 2.31) and major morbidity (OR, 1.60).
Conclusions:
- Multiple prior cardiopulmonary bypass operations are an independent risk factor for mortality and morbidity in reoperative CHD surgery.
- This finding is significant even after controlling for other risk factors and institutional volume.
- Further research is needed to identify modifiable factors to improve outcomes for high-risk patients.
Background:
The increasing number of congenital heart disease patients undergoing reoperative cardiac surgery presents critical and growing challenges. Our objective was to evaluate the association between the number of prior cardiopulmonary bypass operations and operative mortality and morbidity in a national cohort.
Methods:
The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) was reviewed for index cardiac operations on cardiopulmonary bypass during 2016 to 2021. Infants and patients with functionally univentricular physiology were excluded. Multivariable logistic regression adjusted for covariates in the STS-CHSD Mortality Risk Model, the STS-European Association for Cardio-Thoracic Surgery (STAT) Mortality Category, and institutional volume.
Results:
Of 50,625 eligible operations, 22,100 (44%) were performed on patients with ≥1 prior cardiopulmonary bypass operations. Most common diagnoses were tetralogy of Fallot (4340 of 22,100 [19.6%]), pulmonary atresia/ventricular septal defect (1334 of 22,100 [6.0%]), and aortic stenosis (966 of 22,100 [4.4%]). Operative mortality correlated with number of prior cardiopulmonary bypass operations: 157 of 28,525 (0.6%) for 0, 127 of 13,488 (0.9%) for 1, 81 of 5,664 (1.4%) for 2, 61 of 2039 (3.0%) for 3, 35 of 623 (5.6%) for 4, 10 of 207 (4.8%) for 5, and 5 of 79 (6.3%) for ≥6 operations (P < .001). On multivariable analysis, patients with ≥3 prior cardiopulmonary bypass operations had higher risk of operative mortality (odds ratio, 2.31; P < .001) and major morbidity (odds ratio, 1.60; P < .001). Annual institutional volume and age were not associated with either outcome.
Conclusions:
Three or more prior cardiopulmonary bypass operations was an independent risk factor for operative mortality/morbidity, even after controlling for risk factors and institutional volume. Future research is needed to identify modifiable factors to optimize outcomes, particularly for those with ≥3 prior cardiopulmonary bypass operations.
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