Predicting prolonged intensive care unit stay following surgery in adults with Tetralogy of Fallot

As more patients with congenital heart disease survive into adulthood, the number of patients with tetralogy of Fallot (TOF) has also increased. However, long-term sequelae are common, and most patients with TOF require surgical reintervention in adulthood. Prolonged intensive care unit (ICU) stay is associated with poor long-term outcomes following cardiac surgery. This study aimed to investigate whether the PErioperative Adult Congenital Heart disease (PEACH) score can predict prolonged postoperative ICU stay in this population.

Of 1217 patients with congenital heart disease who were ≥18 years old at the time of surgery performed from February 2004 and August 2021, 145 consecutive patients with TOF who underwent right ventricular outflow tract procedures were examined in this single-institution retrospective study. The primary endpoint was ICU stay of ≥3 days.

The population had a history of one sternotomies (median) (1, 2; 1st and 3rd quartiles) at a median age of 35 years (25, 42; 1st and 3rd quartiles). The median duration of ICU stay was one day (1, 2; 1st and 3rd quartiles). Significantly more patients experienced major bleeding and ventilator dependence after surgery than those without prolonged ICU stay. Cardiopulmonary bypass time was significantly longer in patients with prolonged ICU stay than in those without. The PEACH score was independently associated with prolonged ICU stay after adjusted multivariate analyses and had acceptable discriminatory performance for predicting prolonged ICU stay after surgery.

The PEACH score is a useful predictor of prolonged postoperative ICU stay in this population.