Abstract 9230: Intraoperative Residual Lesion Score Predicts Major Residua at Discharge and Early Unplanned Reinterventions Following Congenital Heart Surgery

Abstract

Introduction: The Residual Lesion Score (RLS) has recently been validated as an important predictor of outcomes following congenital heart surgery. However, its reliance on the pre-discharge echocardiogram limits its utility. We assessed the intraoperative RLS (IO-RLS) as a predictor of outcomes following congenital cardiac surgery. Hypothesis: We hypothesized that IO-RLS would be an independent predictor of outcomes following congenital heart surgery. Methods: This was a single center, retrospective review of consecutive patients who underwent congenital cardiac surgery from 01/2011-12/2019. For each index operation, IO-RLS was assigned per the intraoperative echocardiogram using previously published criteria: Class 1, no residua; Class 2, minor residua; Class 3, major residua. Outcomes included major pre-discharge residua or in-hospital unplanned reintervention (primary) and unplanned reinterventions at 1-year post-surgery (secondary). Associations were evaluated using multivariable logistic regression, adjusting for age, prematurity, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality category, and case complexity. Results: Of 6786 patients, 4743 (69.9%), 1903 (28.0%), and 140 (2.1%) patients had Class 1, 2, and 3 lesions, respectively. The primary outcome was observed in 988 (14.6%) patients. Both Class 2 and 3 patients had greater risk of the primary outcome ( Figure 1A ), compared to Class 1 patients. The predicted probability of major pre-discharge residua or in-hospital reintervention by STAT score and IO-RLS is shown in Figure 1B . At 1-year follow-up, 924 (13.6%) patients required reinterventions. IO-RLS Class 2 (OR 1.3, 95% CI 1.1-1.5, p=0.002) and Class 3 (OR 2.4, 95% CI 1.6-3.7, p<0.001) patients had greater risk of the secondary outcome, versus Class 1 patients. Conclusions: IO-RLS may be an important adjunct for self-assessment and quality improvement in congenital heart surgery.