Determinants of adverse in-hospital outcome after cardiac surgery in adults with congenital heart disease

Abstract

Purpose: Patients with congenital heart disease (CHD) often undergo right-sided surgery, and contribution of the right ventricle (RV) to their cardiac pump function is essential. We aimed to identify determinants of adverse outcome after cardiac surgery. Methods: 503 consecutive adults (56% male, median age 36 years) with CHD operated between January 2001 and January 2011 in the Academic Medical Center in Amsterdam were studied. RV function was considered normal for levels of TAPSE and TDI S' above 15mm and 11 cm/s respectively. RV failure was defined as combination of (1) elevated jugular venous pressure, (2) impaired RV function on transthoracic echocardiography and (3) diagnosis of RV failure was documented in the medical charts. Intensive care stay was prolonged if it exceeded four days. The composite end point of an adverse in-hospital outcome was operative mortality, RV failure, inotropes on intensive care, a prolonged intensive care stay, or all. Determinants of adverse outcome were evaluated by logistic regression analysis. Results: Nine patients (1,8%) died peri-operatively, 19 had RV failure, 83 needed inotropic therapy on intensive care and 21 had prolonged intensive care stay. The composite end point was reached in 91 patients (18,1%). Significant pre-operative determinants are shown in the Table. View this table: Table 1. Pre operative determinants of adverse outcome after congenital cardiac surgery Conclusion: Supraventricular arrhythmia, renal function and ventricular function were determinants of adverse in-hospital outcome after congenital cardiac surgery.