Meena Nathan1, Jami C Levine2, Maria I Van Rompay3, Linda M Lambert4, Felicia L Trachtenberg3, Steven D Colan2, Iki Adachi5, Brett R Anderson6, Emile A Bacha7, Aaron Eckhauser8, J William Gaynor9, Eric M Graham10, Benjamin Goot11, Jeffrey P Jacobs12, Rija John5, Jonathan R Kaltman13, Kirk R Kanter14, Carlos M Mery15, L LuAnn Minich4, Richard Ohye16, David Overman17, Christian Pizarro18, Geetha Raghuveer19, Marcus S Schamberger20, Steven M Schwartz21, Shanthi L Narasimhan22, Michael D Taylor23, Ke Wang3, Jane W Newburger2. 1. Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: meena.nathan@cardio.chboston.org. 2. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA. 3. HealthCore, New England Research Institutes, Watertown, Massachusetts, USA. 4. Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA. 5. Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas, USA. 6. Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, USA. 7. Division of Cardiothoracic Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York, USA. 8. Division of Pediatric Cardiothoracic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA. 9. Division of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 10. Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA. 11. Division of Pediatric Cardiology, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 12. Division of Cardiac Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA. 13. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA. 14. Division of Pediatric Cardiac Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. 15. Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas, USA. 16. Division of Pediatric Cardiac Surgery, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA. 17. Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA. 18. Division of Cardiac Surgery, Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington, Delaware, USA. 19. Heart Center, Children's Mercy Hospital, Kansas City, Missouri, USA. 20. Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA. 21. Division of Cardiac Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. 22. Division of Pediatric Cardiology, Masonic Children's Hospital, Minneapolis, Minnesota, USA. 23. Division of Pediatric Cardiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.
Abstract
BACKGROUND: Many factors affect outcomes after congenital cardiac surgery. OBJECTIVES: The RLS (Residual Lesion Score) study explored the impact of severity of residual lesions on post-operative outcomes across operations of varying complexity. METHODS: In a prospective, multicenter, observational study, 17 sites enrolled 1,149 infants undergoing 5 common operations: tetralogy of Fallot repair (n = 250), complete atrioventricular septal defect repair (n = 249), arterial switch operation (n = 251), coarctation or interrupted arch with ventricular septal defect (VSD) repair (n = 150), and Norwood operation (n = 249). The RLS was assigned based on post-operative echocardiography and clinical events: RLS 1 (trivial or no residual lesions), RLS 2 (minor residual lesions), or RLS 3 (reintervention for or major residual lesions before discharge). The primary outcome was days alive and out of hospital within 30 post-operative days (60 for Norwood). Secondary outcomes assessed post-operative course, including major medical events and days in hospital. RESULTS: RLS 3 (vs. RLS 1) was an independent risk factor for fewer days alive and out of hospital (p ≤ 0.008) and longer post-operative hospital stay (p ≤ 0.02) for all 5 operations, and for all secondary outcomes after coarctation or interrupted arch with VSD repair and Norwood (p ≤ 0.03). Outcomes for RLS 1 versus 2 did not differ consistently. RLS alone explained 5% (tetralogy of Fallot repair) to 20% (Norwood) of variation in the primary outcome. CONCLUSIONS: Adjusting for pre-operative factors, residual lesions after congenital cardiac surgery impacted in-hospital outcomes across operative complexity with greatest impact following complex operations. Minor residual lesions had minimal impact. These findings may provide guidance for surgeons when considering short-term risks and benefits of returning to bypass to repair residual lesions.
BACKGROUND: Many factors affect outcomes after congenital cardiac surgery. OBJECTIVES: The RLS (Residual Lesion Score) study explored the impact of severity of residual lesions on post-operative outcomes across operations of varying complexity. METHODS: In a prospective, multicenter, observational study, 17 sites enrolled 1,149 infants undergoing 5 common operations: tetralogy of Fallot repair (n = 250), complete atrioventricular septal defect repair (n = 249), arterial switch operation (n = 251), coarctation or interrupted arch with ventricular septal defect (VSD) repair (n = 150), and Norwood operation (n = 249). The RLS was assigned based on post-operative echocardiography and clinical events: RLS 1 (trivial or no residual lesions), RLS 2 (minor residual lesions), or RLS 3 (reintervention for or major residual lesions before discharge). The primary outcome was days alive and out of hospital within 30 post-operative days (60 for Norwood). Secondary outcomes assessed post-operative course, including major medical events and days in hospital. RESULTS: RLS 3 (vs. RLS 1) was an independent risk factor for fewer days alive and out of hospital (p ≤ 0.008) and longer post-operative hospital stay (p ≤ 0.02) for all 5 operations, and for all secondary outcomes after coarctation or interrupted arch with VSD repair and Norwood (p ≤ 0.03). Outcomes for RLS 1 versus 2 did not differ consistently. RLS alone explained 5% (tetralogy of Fallot repair) to 20% (Norwood) of variation in the primary outcome. CONCLUSIONS: Adjusting for pre-operative factors, residual lesions after congenital cardiac surgery impacted in-hospital outcomes across operative complexity with greatest impact following complex operations. Minor residual lesions had minimal impact. These findings may provide guidance for surgeons when considering short-term risks and benefits of returning to bypass to repair residual lesions.
Authors: Christoph P Hornik; Xia He; Jeffrey P Jacobs; Jennifer S Li; Robert D B Jaquiss; Marshall L Jacobs; Sean M O'Brien; Eric D Peterson; Sara K Pasquali Journal: Ann Thorac Surg Date: 2011-09-19 Impact factor: 4.330
Authors: Meena Nathan; Audrey C Marshall; Jason Kerstein; Hua Liu; Francis Fynn-Thompson; Christopher W Baird; John E Mayer; Frank A Pigula; Pedro J del Nido; Sitaram Emani Journal: Semin Thorac Cardiovasc Surg Date: 2014-12-15
Authors: Michael E A Cunningham; Mary T Donofrio; Syed Murfad Peer; David Zurakowski; Richard A Jonas; Pranava Sinha Journal: Ann Thorac Surg Date: 2016-09-28 Impact factor: 4.330
Authors: Meena Nathan; Lynn A Sleeper; Richard G Ohye; Peter C Frommelt; Christopher A Caldarone; James S Tweddell; Minmin Lu; Gail D Pearson; J William Gaynor; Christian Pizarro; Ismee A Williams; Steven D Colan; Carolyn Dunbar-Masterson; Peter J Gruber; Kevin Hill; Jennifer Hirsch-Romano; Jeffrey P Jacobs; Jonathan R Kaltman; S Ram Kumar; David Morales; Scott M Bradley; Kirk Kanter; Jane W Newburger Journal: J Thorac Cardiovasc Surg Date: 2014-06-19 Impact factor: 5.209
Authors: Meena Nathan; John Karamichalis; Hua Liu; Kimberley Gauvreau; Steven Colan; Matthew Saia; Frank Pigula; Francis Fynn-Thompson; Sitaram Emani; Christopher Baird; John E Mayer; Pedro J del Nido Journal: J Thorac Cardiovasc Surg Date: 2013-09-12 Impact factor: 5.209
Authors: Meena Nathan; Frank A Pigula; Hua Liu; Kimberlee Gauvreau; Steven D Colan; Francis Fynn-Thompson; Sitaram Emani; Christopher A Baird; John E Mayer; Pedro J Del Nido Journal: Ann Thorac Surg Date: 2013-06-16 Impact factor: 4.330
Authors: Luregn J Schlapbach; Kristen S Gibbons; Stephen B Horton; Kerry Johnson; Debbie A Long; David H F Buckley; Simon Erickson; Marino Festa; Yves d'Udekem; Nelson Alphonso; David S Winlaw; Carmel Delzoppo; Kim van Loon; Mark Jones; Paul J Young; Warwick Butt; Andreas Schibler Journal: JAMA Date: 2022-07-05 Impact factor: 157.335