Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease

Pediatric Heart Network Investigators; Meena Nathan; Jami C. Levine; Maria I. Van Rompay; Linda M. Lambert; Felicia L. Trachtenberg; Steven D. Colan; Iki Adachi; Brett R. Anderson; Emile A. Bacha; Aaron Eckhauser; J. William Gaynor; Eric M. Graham; Benjamin Goot; Jeffrey P. Jacobs; Rija John; Jonathan R. Kaltman; Kirk R. Kanter; Carlos M. Mery; L. LuAnn Minich; Richard Ohye; David Overman; Christian Pizarro; Geetha Raghuveer; Marcus S. Schamberger; Steven M. Schwartz; Shanthi L. Narasimhan; Michael D. Taylor; Ke Wang; Jane W. Newburger

doi:10.1016/j.jacc.2021.03.304

Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease

Pediatric Heart Network Investigators, Meena Nathan, Jami C. Levine, Maria I. Van Rompay, Linda M. Lambert, Felicia L. Trachtenberg, Steven D. Colan, Iki Adachi, Brett R. Anderson, Emile A. Bacha, Aaron Eckhauser, J. William Gaynor, Eric M. Graham, Benjamin Goot, Jeffrey P. Jacobs, Rija John, Jonathan R. Kaltman, Kirk R. Kanter, Carlos M. Mery, L. LuAnn MinichRichard Ohye, David Overman, Christian Pizarro, Geetha Raghuveer, Marcus S. Schamberger, Steven M. Schwartz, Shanthi L. Narasimhan, Michael D. Taylor, Ke Wang, Jane W. Newburger

Pediatric Cardiology

Research output: Contribution to journal › Article › peer-review

44 Scopus citations

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.

Original language	English (US)
Pages (from-to)	2382-2394
Number of pages	13
Journal	Journal of the American College of Cardiology
Volume	77
Issue number	19
DOIs	https://doi.org/10.1016/j.jacc.2021.03.304
State	Published - May 18 2021

Bibliographical note

Funding Information:
This study was supported by grants (U24HL135691, U10HL068270, HL109818, HL109778, HL109816, HL109743, HL109741, HL109673, HL068270, HL109781, HL135665, HL135680) from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH). Drs. Nathan and Anderson were supported by K23 grants (NHLBI/NIH HL119600and HL133454, respectively). The views expressed in this paper are those of the authors and do not necessarily represent the views of the NHLBI, NIH, or U.S. Department of Health and Human Services. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2021 American College of Cardiology Foundation

Keywords

days alive and out of the hospital
outcomes
Residual Lesion Score

PubMed: MeSH publication types

Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1016/j.jacc.2021.03.304

Find It

Find It at U of M Libraries

Cite this

Pediatric Heart Network Investigators, Nathan, M., Levine, J. C., Van Rompay, M. I., Lambert, L. M., Trachtenberg, F. L., Colan, S. D., Adachi, I., Anderson, B. R., Bacha, E. A., Eckhauser, A., Gaynor, J. W., Graham, E. M., Goot, B., Jacobs, J. P., John, R., Kaltman, J. R., Kanter, K. R., Mery, C. M., ... Newburger, J. W. (2021). Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease. Journal of the American College of Cardiology, 77(19), 2382-2394. https://doi.org/10.1016/j.jacc.2021.03.304

Pediatric Heart Network Investigators, Nathan, M, Levine, JC, Van Rompay, MI, Lambert, LM, Trachtenberg, FL, Colan, SD, Adachi, I, Anderson, BR, Bacha, EA, Eckhauser, A, Gaynor, JW, Graham, EM, Goot, B, Jacobs, JP, John, R, Kaltman, JR, Kanter, KR, Mery, CM, LuAnn Minich, L, Ohye, R, Overman, D, Pizarro, C, Raghuveer, G, Schamberger, MS, Schwartz, SM, Narasimhan, SL, Taylor, MD, Wang, K & Newburger, JW 2021, 'Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease', Journal of the American College of Cardiology, vol. 77, no. 19, pp. 2382-2394. https://doi.org/10.1016/j.jacc.2021.03.304

@article{bc0eea9f36af4a1193eff19e9dd918ec,

title = "Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease",

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.",

keywords = "days alive and out of the hospital, outcomes, Residual Lesion Score",

author = "{Pediatric Heart Network Investigators} and Meena Nathan and Levine, {Jami C.} and {Van Rompay}, {Maria I.} and Lambert, {Linda M.} and Trachtenberg, {Felicia L.} and Colan, {Steven D.} and Iki Adachi and Anderson, {Brett R.} and Bacha, {Emile A.} and Aaron Eckhauser and Gaynor, {J. William} and Graham, {Eric M.} and Benjamin Goot and Jacobs, {Jeffrey P.} and Rija John and Kaltman, {Jonathan R.} and Kanter, {Kirk R.} and Mery, {Carlos M.} and {LuAnn Minich}, L. and Richard Ohye and David Overman and Christian Pizarro and Geetha Raghuveer and Schamberger, {Marcus S.} and Schwartz, {Steven M.} and Narasimhan, {Shanthi L.} and Taylor, {Michael D.} and Ke Wang and Newburger, {Jane W.}",

note = "Funding Information: This study was supported by grants (U24HL135691, U10HL068270, HL109818, HL109778, HL109816, HL109743, HL109741, HL109673, HL068270, HL109781, HL135665, HL135680) from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH). Drs. Nathan and Anderson were supported by K23 grants (NHLBI/NIH HL119600and HL133454, respectively). The views expressed in this paper are those of the authors and do not necessarily represent the views of the NHLBI, NIH, or U.S. Department of Health and Human Services. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = may,

day = "18",

doi = "10.1016/j.jacc.2021.03.304",

language = "English (US)",

volume = "77",

pages = "2382--2394",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "19",

}

TY - JOUR

T1 - Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease

AU - Pediatric Heart Network Investigators

AU - Nathan, Meena

AU - Levine, Jami C.

AU - Van Rompay, Maria I.

AU - Lambert, Linda M.

AU - Trachtenberg, Felicia L.

AU - Colan, Steven D.

AU - Adachi, Iki

AU - Anderson, Brett R.

AU - Bacha, Emile A.

AU - Eckhauser, Aaron

AU - Gaynor, J. William

AU - Graham, Eric M.

AU - Goot, Benjamin

AU - Jacobs, Jeffrey P.

AU - John, Rija

AU - Kaltman, Jonathan R.

AU - Kanter, Kirk R.

AU - Mery, Carlos M.

AU - LuAnn Minich, L.

AU - Ohye, Richard

AU - Overman, David

AU - Pizarro, Christian

AU - Raghuveer, Geetha

AU - Schamberger, Marcus S.

AU - Schwartz, Steven M.

AU - Narasimhan, Shanthi L.

AU - Taylor, Michael D.

AU - Wang, Ke

AU - Newburger, Jane W.

N1 - Funding Information: This study was supported by grants (U24HL135691, U10HL068270, HL109818, HL109778, HL109816, HL109743, HL109741, HL109673, HL068270, HL109781, HL135665, HL135680) from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH). Drs. Nathan and Anderson were supported by K23 grants (NHLBI/NIH HL119600and HL133454, respectively). The views expressed in this paper are those of the authors and do not necessarily represent the views of the NHLBI, NIH, or U.S. Department of Health and Human Services. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021/5/18

Y1 - 2021/5/18

N2 - 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.

AB - 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.

KW - days alive and out of the hospital

KW - outcomes

KW - Residual Lesion Score

UR - http://www.scopus.com/inward/record.url?scp=85105026207&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85105026207&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2021.03.304

DO - 10.1016/j.jacc.2021.03.304

M3 - Article

C2 - 33985683

AN - SCOPUS:85105026207

SN - 0735-1097

VL - 77

SP - 2382

EP - 2394

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 19

ER -

Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this