Henri Haapanen1, Victor Tsang2, Aleksander Kempny3, Ralph Neijenhuis4, Fiona Kennedy5, Seamus Cullen5, Fiona Walker5, Martin Kostolny4, Tain-Yen Hsia6, Carin Van Doorn7. 1. Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom; Department of Surgery, North Karelia Central Hospital, Joensuu, Finland. 2. Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom; Grown-up Congenital Heart Unit, St Bartholomew's Hospital, London, United Kingdom. Electronic address: victor.tsang@gosh.nhs.uk. 3. Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom. 4. Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom. 5. Grown-up Congenital Heart Unit, St Bartholomew's Hospital, London, United Kingdom. 6. Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom; Grown-up Congenital Heart Unit, St Bartholomew's Hospital, London, United Kingdom; Pediatric Cardiac Surgery, Yale New Haven Children's Hospital, New Haven, Connecticut. 7. Department of Congenital Cardiac Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom.
Abstract
BACKGROUND: Surgery in grown-ups with congenital heart disease (GUCH) is characterized by complex anatomy, comorbidities, reoperations, and technical challenges. Although 30-day postoperative mortality is low, this measure might be insufficient to reflect adverse outcome monitoring. Our study aimed to establish whether prolonged intensive care unit (ICU) stay (≥7 days) and 6-month mortality were more clinically meaningful measures than 30-day mortality and to identify predictors of adverse outcome. METHODS: All consecutive GUCH patients from 1998 to 2015 were identified. Perioperative characteristics, diagnoses, and postoperative data were collected retrospectively. Predictors of 30-day and 6-month mortality and prolonged ICU stay were determined with logistic regression. Era effect was tested for quality assurances by dividing the cohort into 4 time intervals. RESULTS: Within 17 years, 1093 consecutive cardiac surgical procedures were identified in 1026 GUCH patients. During the study period, 30-day mortality improved significantly, with an overall 30-day mortality of 1.5%; 6-month mortality and prolonged ICU stay were 2.4% and 6.7%, respectively. Despite a decreased number of preoperative patients in New York Heart Association Functional Classification III or higher, prolonged ICU stay increased over the eras. Predictors of adverse outcome were New York Heart Association class III or higher, preoperative renal failure, disease of great complexity, preoperative ventilator support, cardiopulmonary bypass time, and concomitant procedures. CONCLUSIONS: In the current era of low 30-day mortality, extended 6-month mortality and prolonged ICU stay reporting may be more realistic measures of adverse outcomes for counseling GUCH patients at risk.
BACKGROUND: Surgery in grown-ups with congenital heart disease (GUCH) is characterized by complex anatomy, comorbidities, reoperations, and technical challenges. Although 30-day postoperative mortality is low, this measure might be insufficient to reflect adverse outcome monitoring. Our study aimed to establish whether prolonged intensive care unit (ICU) stay (≥7 days) and 6-month mortality were more clinically meaningful measures than 30-day mortality and to identify predictors of adverse outcome. METHODS: All consecutive GUCH patients from 1998 to 2015 were identified. Perioperative characteristics, diagnoses, and postoperative data were collected retrospectively. Predictors of 30-day and 6-month mortality and prolonged ICU stay were determined with logistic regression. Era effect was tested for quality assurances by dividing the cohort into 4 time intervals. RESULTS: Within 17 years, 1093 consecutive cardiac surgical procedures were identified in 1026 GUCH patients. During the study period, 30-day mortality improved significantly, with an overall 30-day mortality of 1.5%; 6-month mortality and prolonged ICU stay were 2.4% and 6.7%, respectively. Despite a decreased number of preoperative patients in New York Heart Association Functional Classification III or higher, prolonged ICU stay increased over the eras. Predictors of adverse outcome were New York Heart Association class III or higher, preoperative renal failure, disease of great complexity, preoperative ventilator support, cardiopulmonary bypass time, and concomitant procedures. CONCLUSIONS: In the current era of low 30-day mortality, extended 6-month mortality and prolonged ICU stay reporting may be more realistic measures of adverse outcomes for counseling GUCH patients at risk.