Risk factors and early outcomes of multiple reoperations in adults with 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

57 Citations (Scopus)

Abstract

Background: Advances in treatment of congenital heart disease (CHD) have resulted in most patients surviving to adulthood. Despite surgical "correction," the need for reoperation(s) persists, and there are few outcome data. This study examined early postoperative results to determine risk factors for cardiac injury and early death in adults with CHD undergoing repeat median sternotomy. Methods: Data from the most recent median sternotomy of 984 adults (49% male) with CHD were analyzed. Mean age at operation was 36.4 years. Diagnoses were conotruncal anomaly, 361 (37%); Ebstein/Tricuspid valve, 174 (18%); pulmonary stenosis/right ventricular outflow tract obstruction, 92 (9%); single ventricle, 71 (7%); atrioventricular septal defect, 64 (7%); subaortic stenosis, 62 (6%); aortic arch abnormalities, 23 (2%); anomalous pulmonary vein, 21 (2%); Marfan syndrome, 14 (1%); and other, 102 (10%). Results: Overall early mortality was 3.6%: including 2%, 6%, 7%, and 0% at sternotomy 2 (n = 597), 3 (n = 284), 4 (n = 72), and 5+ (n = 31), respectively. Cardiac injury occurred in 6%. Independent predictors of cardiac injury were single-ventricle diagnosis and increased number of prior sternotomies. Increased time from previous sternotomy decreased the incidence of cardiac injury. Independent risk factors for early death were urgent operation, single-ventricle diagnosis, and longer bypass time. Increased preoperative ejection fraction decreased early mortality. Conclusions: Subsequent sternotomy showed increased early mortality, yet neither sternotomy number nor cardiac injury was an independent predictor of early death. Two variables were protective: early mortality was reduced with increased ejection fraction and cardiac injury was less likely with increased interval from the previous sternotomy.

Original languageEnglish (US)
Pages (from-to)122-130
Number of pages9
JournalAnnals of Thoracic Surgery
Volume92
Issue number1
DOIs
StatePublished - Jul 2011

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Sternotomy
Reoperation
Heart Diseases
Wounds and Injuries
Mortality
Ventricular Outflow Obstruction
Pulmonary Valve Stenosis
Tricuspid Valve
Pulmonary Veins
Thoracic Aorta
Pathologic Constriction
Incidence

ASJC Scopus subject areas

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

Cite this

Risk factors and early outcomes of multiple reoperations in adults with 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. 92, No. 1, 07.2011, p. 122-130.

Research output: Contribution to journalArticle

Holst, Kimberly A. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Connolly, Heidi M. ; Warnes, Carole A. ; Li, Zhuo ; Schaff, Hartzell V. / Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 1. pp. 122-130.
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AU - Holst, Kimberly A.

AU - Dearani, Joseph A.

AU - Burkhart, Harold M.

AU - Connolly, Heidi M.

AU - Warnes, Carole A.

AU - Li, Zhuo

AU - Schaff, Hartzell V

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AB - Background: Advances in treatment of congenital heart disease (CHD) have resulted in most patients surviving to adulthood. Despite surgical "correction," the need for reoperation(s) persists, and there are few outcome data. This study examined early postoperative results to determine risk factors for cardiac injury and early death in adults with CHD undergoing repeat median sternotomy. Methods: Data from the most recent median sternotomy of 984 adults (49% male) with CHD were analyzed. Mean age at operation was 36.4 years. Diagnoses were conotruncal anomaly, 361 (37%); Ebstein/Tricuspid valve, 174 (18%); pulmonary stenosis/right ventricular outflow tract obstruction, 92 (9%); single ventricle, 71 (7%); atrioventricular septal defect, 64 (7%); subaortic stenosis, 62 (6%); aortic arch abnormalities, 23 (2%); anomalous pulmonary vein, 21 (2%); Marfan syndrome, 14 (1%); and other, 102 (10%). Results: Overall early mortality was 3.6%: including 2%, 6%, 7%, and 0% at sternotomy 2 (n = 597), 3 (n = 284), 4 (n = 72), and 5+ (n = 31), respectively. Cardiac injury occurred in 6%. Independent predictors of cardiac injury were single-ventricle diagnosis and increased number of prior sternotomies. Increased time from previous sternotomy decreased the incidence of cardiac injury. Independent risk factors for early death were urgent operation, single-ventricle diagnosis, and longer bypass time. Increased preoperative ejection fraction decreased early mortality. Conclusions: Subsequent sternotomy showed increased early mortality, yet neither sternotomy number nor cardiac injury was an independent predictor of early death. Two variables were protective: early mortality was reduced with increased ejection fraction and cardiac injury was less likely with increased interval from the previous sternotomy.

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