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The risk associated with concomitant procedures performed during adult congenital heart surgery

Published online by Cambridge University Press:  08 September 2015

Makoto Mori ,
Joshua M. Rosenblum ,
Wendy Book ,
Matt Oster  and
Brian Kogon
Makoto Mori
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Joshua M. Rosenblum
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
Wendy Book
Affiliation:
Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
Matt Oster
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Brian Kogon*
Affiliation:
Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
*
Correspondence to: B. E. Kogon, MD, Department of Pediatric Cardiothoracic Surgery, Children’s Healthcare of Atlanta, Emory University, Egleston, 1405 Clifton Road NE, Atlanta, GA 30322, United States of America. Tel: +404 785 6319; Fax: +404 785 6265; E-mail: [email protected]
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Abstract

Background

Adult patients with CHD often require complex operations, and indications for particular aspects of the operation are sometimes unclear. The aims of our study were as follows: to characterise concomitant procedures performed during adult congenital cardiac surgery, and to better define the risk involved with performing concomitant procedures during a single operation.

Methods

We retrospectively studied 458 adult congenital cardiac surgical patients. Major procedures were characterised as aortic, mitral, pulmonary, tricuspid, septal defect, single ventricle, transplant, and others. We constructed logistic regression models to assess the risk for mortality, major adverse event, and prolonged length of stay.

Results

A total of 362 operations involved a single major procedure, whereas 96 involved concomitant procedures. Performing concomitant procedures increased mortality (7.3 versus 2.5%), major adverse events (21.8 versus 14.9%), and prolonged length of stay (29.2 versus 17.1%). The added risks of concomitant procedures on mortality, major adverse event, and prolonged length of stay were 2.9 (95% CI 1.0–8.5, p=0.05), 1.9 (95% CI 1.1–3.3, p=0.02), and 2.4 (95% CI 1.4–4.1, p=0.003), respectively. There were 200 patients with conotruncal anomalies who underwent pulmonary valve surgery. In this subset, the added risks of concomitant procedures in addition to pulmonary valve surgery on mortality, major adverse events, and prolonged length of stay were 6.6 (95% CI 1.2–37.3, p=0.03), 2.8 (95% CI 1.2–6.6, p=0.03), and 3.3 (95% CI 1.5–7.4, p=0.005), respectively.

Conclusion

Concomitant procedures performed during adult congenital heart surgery increase risk. Awareness of this risk may improve surgical decision making and outcomes.

Keywords

Adult congenitalconcomitant operationsrisk
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 909 - 914
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Copyright
© Cambridge University Press 2015 

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References

1. Warnes, CA. The adult with congenital heart disease – born to be bad? J Am Coll Cardiol 2005; 46: 1–8.Google Scholar
2. Kogon, B, Grudziak, J, Sahu, A, et al. Surgery in adults with congenital heart disease: risk factors for morbidity and mortality. Ann Thora Surg 2013; 95: 1377–1382.Google Scholar
3. Jain, A, Oster, M, Kilgo, P, et al. Risk factors associated with morbidity and mortality following pulmonary valve replacement in adults with previously corrected Tetralogy of Fallot. Pediatr Cardiol 2012; 33: 601–606.Google Scholar
4. Warnes, C, Williams, R, Bashore, T. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults with Congenital Heart Disease). Circulation 2008; 118: e714–e833.Google Scholar
5. Nishimura, R, Otto, C, Bonow, R, et al. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57–e185.Google Scholar
6. Shinn, SH, Schaff, HV. Evidence-based surgical management of acquired tricuspid valve disease. Nat Rev Cardiol 2013; 10: 190–203.Google Scholar
7. Kogon, B, Patel, M, Leong, T, et al. Management of moderate functional tricuspid valve regurgitation at the time of pulmonary valve replacement: is concomitant tricuspid valve repair necessary? Pediatr Cardiol 2010; 31: 843–848.CrossRefGoogle ScholarPubMed
8. Kogon, B, Mori, M, Alsoufi, B, Kanter, K, Oster, M. Leaving moderate tricuspid valve regurgitation alone at the time of pulmonary valve replacement: a worthwhile approach. Ann Thorac Surg 2015; 99: 2117–2123.Google Scholar
9. Stulak, JM, Dearani, JA, Burkhart, HM, et al. Does the dilated ascending aorta in an adult with congenital heart disease require intervention? J Thorac Cardiovasc Surg 2010; 140: S52–S57.Google Scholar
10. Dearani, JA, Burkhart, HM, Stulak, JM, et al. Management of the aortic root in adult patients with conotruncal anomalies. Semin Thorac Cardiovasc Surg 2009: 122–129.Google Scholar