Reoperative multivalve surgery in adult congenital heart disease

Kimberly A. Holst, Joseph A. Dearani, Harold M. Burkhart, Heidi M. Connolly, Carole A. Warnes, Zhuo Li, Hartzell V Schaff

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Repeat operations are common in adult congenital heart disease (ACHD) and valve-related procedures are the most frequent indication for intervention. The purpose of this study is to review a single institution's experience with a large number of patients with ACHD undergoing reoperation requiring multivalve intervention. Methods: Data from the most recent repeat median sternotomy of 254 consecutive ACHD patients with simultaneous intervention on 2 or more valves were analyzed. Mean age of 136 (54%) female and 118 (46%) male patients was 37.9 years (range, 18 to 83). Diagnoses were conotruncal anomaly 132 (52%), Ebstein-tricuspid valve 41(16%), pulmonary stenosis and right ventricular outflow tract obstruction 37 (14%), atrioventricular septal defect 22 (9%), and other 22 (9%). It was the second sternotomy in 130 (51%) patients, third in 80 (31%), fourth in 34 (13%), and fifth in 10 (4%). Results: Intervention was on 2 valves in 219 patients (86.2%), 3 in 34 patients (13.4%), and 4 in 1 patient (0.4%). The most common valve combination was tricuspid and pulmonary (117, 43%). Early mortality overall was 4.7% (12 of 254) and 2.9% (7 of 239) after elective operation. Potentially modifiable risk factors identified for early mortality were preoperative hematocrit less than 35 (p = 0.01), cross-clamp time (p < 0.001), and cardiopulmonary bypass time (p < 0.001). Late survival was 96%, 89%, and 77% at 1, 5, and 10 years, respectively. Independent risk factors for late mortality were prolonged ventilation (p = 0.002), coronary artery disease (p = 0.005), and cardiac injury (p = 0.018). Conclusions: The need for simultaneous intervention on multiple valves is relatively common in ACHD, particularly with conotruncal anomalies. Prolonged bypass and cross-clamp times, lower hematocrit, and acquired coronary artery disease are significant predictors of adverse outcome. The number or position of valves requiring intervention did not affect early or late survival.

Original languageEnglish (US)
Pages (from-to)1383-1389
Number of pages7
JournalAnnals of Thoracic Surgery
Volume95
Issue number4
DOIs
StatePublished - Apr 2013

Fingerprint

Heart Diseases
Sternotomy
Hematocrit
Mortality
Coronary Artery Disease
Ventricular Outflow Obstruction
Heart Valve Diseases
Pulmonary Valve Stenosis
Tricuspid Valve
Survival
Cardiopulmonary Bypass
Reoperation
Ventilation
Lung
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Holst, K. A., Dearani, J. A., Burkhart, H. M., Connolly, H. M., Warnes, C. A., Li, Z., & Schaff, H. V. (2013). Reoperative multivalve surgery in adult congenital heart disease. Annals of Thoracic Surgery, 95(4), 1383-1389. https://doi.org/10.1016/j.athoracsur.2012.12.009

Reoperative multivalve surgery in adult congenital heart disease. / Holst, Kimberly A.; Dearani, Joseph A.; Burkhart, Harold M.; Connolly, Heidi M.; Warnes, Carole A.; Li, Zhuo; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 95, No. 4, 04.2013, p. 1383-1389.

Research output: Contribution to journalArticle

Holst, KA, Dearani, JA, Burkhart, HM, Connolly, HM, Warnes, CA, Li, Z & Schaff, HV 2013, 'Reoperative multivalve surgery in adult congenital heart disease', Annals of Thoracic Surgery, vol. 95, no. 4, pp. 1383-1389. https://doi.org/10.1016/j.athoracsur.2012.12.009
Holst KA, Dearani JA, Burkhart HM, Connolly HM, Warnes CA, Li Z et al. Reoperative multivalve surgery in adult congenital heart disease. Annals of Thoracic Surgery. 2013 Apr;95(4):1383-1389. https://doi.org/10.1016/j.athoracsur.2012.12.009
Holst, Kimberly A. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Connolly, Heidi M. ; Warnes, Carole A. ; Li, Zhuo ; Schaff, Hartzell V. / Reoperative multivalve surgery in adult congenital heart disease. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 4. pp. 1383-1389.
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abstract = "Background: Repeat operations are common in adult congenital heart disease (ACHD) and valve-related procedures are the most frequent indication for intervention. The purpose of this study is to review a single institution's experience with a large number of patients with ACHD undergoing reoperation requiring multivalve intervention. Methods: Data from the most recent repeat median sternotomy of 254 consecutive ACHD patients with simultaneous intervention on 2 or more valves were analyzed. Mean age of 136 (54{\%}) female and 118 (46{\%}) male patients was 37.9 years (range, 18 to 83). Diagnoses were conotruncal anomaly 132 (52{\%}), Ebstein-tricuspid valve 41(16{\%}), pulmonary stenosis and right ventricular outflow tract obstruction 37 (14{\%}), atrioventricular septal defect 22 (9{\%}), and other 22 (9{\%}). It was the second sternotomy in 130 (51{\%}) patients, third in 80 (31{\%}), fourth in 34 (13{\%}), and fifth in 10 (4{\%}). Results: Intervention was on 2 valves in 219 patients (86.2{\%}), 3 in 34 patients (13.4{\%}), and 4 in 1 patient (0.4{\%}). The most common valve combination was tricuspid and pulmonary (117, 43{\%}). Early mortality overall was 4.7{\%} (12 of 254) and 2.9{\%} (7 of 239) after elective operation. Potentially modifiable risk factors identified for early mortality were preoperative hematocrit less than 35 (p = 0.01), cross-clamp time (p < 0.001), and cardiopulmonary bypass time (p < 0.001). Late survival was 96{\%}, 89{\%}, and 77{\%} at 1, 5, and 10 years, respectively. Independent risk factors for late mortality were prolonged ventilation (p = 0.002), coronary artery disease (p = 0.005), and cardiac injury (p = 0.018). Conclusions: The need for simultaneous intervention on multiple valves is relatively common in ACHD, particularly with conotruncal anomalies. Prolonged bypass and cross-clamp times, lower hematocrit, and acquired coronary artery disease are significant predictors of adverse outcome. The number or position of valves requiring intervention did not affect early or late survival.",
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AU - Holst, Kimberly A.

AU - Dearani, Joseph A.

AU - Burkhart, Harold M.

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AU - Warnes, Carole A.

AU - Li, Zhuo

AU - Schaff, Hartzell V

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N2 - Background: Repeat operations are common in adult congenital heart disease (ACHD) and valve-related procedures are the most frequent indication for intervention. The purpose of this study is to review a single institution's experience with a large number of patients with ACHD undergoing reoperation requiring multivalve intervention. Methods: Data from the most recent repeat median sternotomy of 254 consecutive ACHD patients with simultaneous intervention on 2 or more valves were analyzed. Mean age of 136 (54%) female and 118 (46%) male patients was 37.9 years (range, 18 to 83). Diagnoses were conotruncal anomaly 132 (52%), Ebstein-tricuspid valve 41(16%), pulmonary stenosis and right ventricular outflow tract obstruction 37 (14%), atrioventricular septal defect 22 (9%), and other 22 (9%). It was the second sternotomy in 130 (51%) patients, third in 80 (31%), fourth in 34 (13%), and fifth in 10 (4%). Results: Intervention was on 2 valves in 219 patients (86.2%), 3 in 34 patients (13.4%), and 4 in 1 patient (0.4%). The most common valve combination was tricuspid and pulmonary (117, 43%). Early mortality overall was 4.7% (12 of 254) and 2.9% (7 of 239) after elective operation. Potentially modifiable risk factors identified for early mortality were preoperative hematocrit less than 35 (p = 0.01), cross-clamp time (p < 0.001), and cardiopulmonary bypass time (p < 0.001). Late survival was 96%, 89%, and 77% at 1, 5, and 10 years, respectively. Independent risk factors for late mortality were prolonged ventilation (p = 0.002), coronary artery disease (p = 0.005), and cardiac injury (p = 0.018). Conclusions: The need for simultaneous intervention on multiple valves is relatively common in ACHD, particularly with conotruncal anomalies. Prolonged bypass and cross-clamp times, lower hematocrit, and acquired coronary artery disease are significant predictors of adverse outcome. The number or position of valves requiring intervention did not affect early or late survival.

AB - Background: Repeat operations are common in adult congenital heart disease (ACHD) and valve-related procedures are the most frequent indication for intervention. The purpose of this study is to review a single institution's experience with a large number of patients with ACHD undergoing reoperation requiring multivalve intervention. Methods: Data from the most recent repeat median sternotomy of 254 consecutive ACHD patients with simultaneous intervention on 2 or more valves were analyzed. Mean age of 136 (54%) female and 118 (46%) male patients was 37.9 years (range, 18 to 83). Diagnoses were conotruncal anomaly 132 (52%), Ebstein-tricuspid valve 41(16%), pulmonary stenosis and right ventricular outflow tract obstruction 37 (14%), atrioventricular septal defect 22 (9%), and other 22 (9%). It was the second sternotomy in 130 (51%) patients, third in 80 (31%), fourth in 34 (13%), and fifth in 10 (4%). Results: Intervention was on 2 valves in 219 patients (86.2%), 3 in 34 patients (13.4%), and 4 in 1 patient (0.4%). The most common valve combination was tricuspid and pulmonary (117, 43%). Early mortality overall was 4.7% (12 of 254) and 2.9% (7 of 239) after elective operation. Potentially modifiable risk factors identified for early mortality were preoperative hematocrit less than 35 (p = 0.01), cross-clamp time (p < 0.001), and cardiopulmonary bypass time (p < 0.001). Late survival was 96%, 89%, and 77% at 1, 5, and 10 years, respectively. Independent risk factors for late mortality were prolonged ventilation (p = 0.002), coronary artery disease (p = 0.005), and cardiac injury (p = 0.018). Conclusions: The need for simultaneous intervention on multiple valves is relatively common in ACHD, particularly with conotruncal anomalies. Prolonged bypass and cross-clamp times, lower hematocrit, and acquired coronary artery disease are significant predictors of adverse outcome. The number or position of valves requiring intervention did not affect early or late survival.

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