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The Association Between Residual Lesion Score and Long-term Outcomes of Congenital Cardiac Operations
Teerapong Tocharoenchok1, Kok Hooi Yap2, Brigitte Mueller3
1Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
The residual lesion score (RLS) after congenital heart surgery does not predict long-term mortality. However, a higher RLS score indicates an increased risk of late reoperations, aiding in patient follow-up strategies.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Clinical Outcomes Research
Background:
- The residual lesion score (RLS) is a post-surgical metric used in congenital heart disease (CHD) repair.
- Understanding the long-term impact of RLS on patient outcomes is crucial for optimizing care.
Purpose of the Study:
- To investigate the association between the residual lesion score (RLS) and long-term outcomes following five common congenital heart operations.
- To determine if RLS can predict late mortality or the need for reintervention/reoperation.
Main Methods:
- A retrospective study of 1027 infants undergoing repair for specific CHD between 2000-2012.
- RLS was assigned post-repair (1=none, 2=minor, 3=major/reintervention).
- Kaplan-Meier and competing risk models analyzed time-to-event data.
Main Results:
- Median follow-up was 15 years. RLS was not linked to late death or heart transplantation.
- Patients with RLS of 3 had a significantly higher risk of late reintervention or reoperation (HR 2.02).
- Younger age, specific diagnoses (TOF), and surgical factors also predicted reoperation.
Conclusions:
- The residual lesion score (RLS) is not a predictor of late mortality after CHD repair.
- RLS is a valuable tool for predicting late reintervention or reoperation, enabling targeted patient follow-up.
- This scoring system can help identify high-risk patients needing closer monitoring post-surgery.
Background:
This study sought to investigate the impact of the residual lesion score (RLS) on the long-term outcomes of 5 common congenital heart operations.
Methods:
All infants who underwent definitive operation for complete atrioventricular septal defect, tetralogy of Fallot (TOF), dextro-transposition of the great arteries, single ventricle (Norwood procedure), and coarctation of the aorta with ventricular septal defect between 2000 and 2012 and who survived until discharge were studied. RLS scores (1, no or trivial; 2, minor; 3, major or in-hospital reinterventions or reoperations for such lesions) were assigned on the basis of postrepair clinical and echocardiographic evaluation. The time to events was summarized using the Kaplan-Meier survival method and competing risk models.
Results:
A total of 1027 patients were included (213 atrioventricular septal defects, 358 TOFs, 308 dextro-transpositions of the great arteries, 127 single ventricles, and 21 coarctations of the aorta with ventricular septal defects), with a median follow-up time of 15 years (interquartile range, 11-18.4 years). Overall, 227 patients (22.1%) had an RLS of 1, 556 patients (54.1%) had an RLS of 2, and 244 patients (23.8%) had an RLS of 3. Freedom from late death or heart transplantation was 93.7% at 15 years. The RLS was not associated with late death or transplantation. Male sex, TOF, and arterial switch operation had the lowest risk for late death or transplantation. Late reinterventions or reoperations were present in 14.5% at 15 years. Younger age, TOF with pulmonary stenosis repair, arterial switch operation, an RLS of 3 (hazard ratio, 2.02; 95% CI, 1.17-3.51; P = .012), intraoperative surgical revision, and in-hospital reintervention or reoperation were associated with late reintervention or reoperation.
Conclusions:
The RLS does not predict late mortality but predicts late reintervention or reoperation after congenital cardiac disease repair and can be used to target at-risk patients for follow-up.
