Impact of Major Residual Lesions on Outcomes After Surgery for Congenital Heart Disease

BACKGROUND Many factors affect outcomes after congenital cardiac surgery. OBJECTIVES The RLS (Residual Lesion Score) study explored the impact of severity of residual lesions on postoperative outcomes across operations of varying complexity. METHODS In a prospective, multicenter, observational study, 17 sites enrolled 1,149 infants undergoing 5 common operations: tetralogy of Fallot repair (n = 250), complete atrioventricular septal defect repair (n = 249), arterial switch operation (n = 251), coarctation or interrupted arch with ventricular septal defect (VSD) repair (n = 150), and Norwood operation (n = 249). The RLS was assigned based on post-operative echocardiography and clinical events: RLS 1 (trivial or no residual lesions), RLS 2 (minor residual lesions), or RLS 3 (reintervention for or major residual lesions before discharge). The primary outcome was days alive and out of hospital within 30 post-operative days (60 for Norwood). Secondary outcomes assessed post-operative course, including major medical events and days in hospital. RESULTS RLS 3 (vs. RLS 1) was an independent risk factor for fewer days alive and out of hospital (p <-0.008) and longer post-operative hospital stay (p <-0.02) for all 5 operations, and for all secondary outcomes after coarctation or interrupted arch with VSD repair and Norwood (p <-0.03). Outcomes for RLS 1 versus 2 did not differ consistently. RLS alone explained 5% (tetralogy of Fallot repair) to 20% (Norwood) of variation in the primary outcome. CONCLUSIONS Adjusting for pre-operative factors, residual lesions after congenital cardiac surgery impacted in hospital outcomes across operative complexity with greatest impact following complex operations. Minor residual lesions had minimal impact. These findings may provide guidance for surgeons when considering short-term risks and benefits of returning to bypass to repair residual lesions. (J Am Coll Cardiol 2021;77:2382-94) (c) 2021 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

Automated summary

The severity of residual lesions after congenital cardiac surgery has a significant impact on postoperative outcomes, with greater impact following complex operations. Minor residual lesions have minimal impact on outcomes.