Enhanced Assessment of Perioperative Mortality Risk in Adults With Congenital Heart Disease

Constantine, Andrew; Costola, G; Bianchi, Paolo; Chessa, Massimo; Giamberti, Alessandro; Kempny, Aleksander; Rafiq, Isma; Babu‐Narayan, Sonya V.; Hoschtitzky, Andreas; Shore, Darryl F.; Aw, Tuan‐Chen; Ranucci, Marco; Dimopoulos, Konstantinos

doi:10.1016/j.jacc.2021.04.096

Cited by 25 publications

(13 citation statements)

References 18 publications

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“…Recently published data suggest that previous cardiac surgery is a risk factor for surgical mortality in adults with CHD. 29 , 30 , 31 In our study, previous cardiac surgery was associated with a lower likelihood of LV normalization on follow‐up. Despite major advances in percutaneous interventions in the past decades, these are largely avoided in young individuals with AR due to technical (small aortic annulus, lack of calcification and associated aortopathy, etc) and possible valve durability issues, hence are reserved for older patients in whom the surgical risk is significant.…”

Section: Discussionsupporting

confidence: 48%

Repair of Aortic Regurgitation in Young Adults: Sooner Rather Than Later

Barradas‐Pires,

Merás,

Constantine

et al. 2023

JAHA

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Background Establishing surgical criteria for aortic valve replacement (AVR) in severe aortic regurgitation in young adults is challenging due to the lack of evidence‐based recommendations. We studied indications for AVR in young adults with severe aortic regurgitation and their outcomes, as well as the relationship between presurgical echocardiographic parameters and postoperative left ventricular (LV) size, function, clinical events, and valve‐related complications. Methods and Results Data were collected retrospectively on 172 consecutive adult patients who underwent AVR or repair for severe aortic regurgitation between 2005 and 2019 in a tertiary cardiac center (age at surgery 29 [22–41] years, 81% male). One‐third underwent surgery before meeting guideline indications. Postsurgery, 65% achieved LV size and function normalization. LV ejection fraction showed no significant change from baseline. A higher presurgical LV end‐systolic diameter correlated with a lack of LV normalization (odds ratio per 1‐cm increase 2.81, P <0.01). The baseline LV end‐systolic diameter cut‐off for predicting lack of LV normalization was 43 mm. Pre‐ and postoperative LV dimensions and postoperative LV ejection fraction predicted clinical events during follow‐up. Prosthetic valve‐related complications occurred in 20.3% during an average 5.6‐year follow‐up. Freedom from aortic reintervention was 98%, 96.5%, and 85.4% at 1, 5, and 10 years, respectively. Conclusions Young adult patients with increased baseline LV end‐systolic diameter or prior cardiac surgery are less likely to achieve LV normalization after AVR. Clinicians should carefully balance the long‐term benefits of AVR against procedural risks and future interventions, especially in younger patients. Evidence‐based criteria for AVR in severe aortic regurgitation in young adults are crucial to improve outcomes.

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Section: Discussionsupporting

confidence: 48%

Repair of Aortic Regurgitation in Young Adults: Sooner Rather Than Later

Barradas‐Pires,

Merás,

Constantine

et al. 2023

JAHA

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“…Finally, they importantly demonstrated that operating on these patients at an earlier stage and before they reach failure decreases the risks of these operations. This goes along with the recent PEACH score publication by Constantine et al [ 7 ] who showed that, for similar lesions, adults with congenital heart disease should have a reoperation far earlier than their counterparts with biventricular circulation and acquired heart disease.…”

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confidence: 62%

The Fontan procedure is no longer the last operation

Venna

d’Udekem

2022

Interactive CardioVascular and Thoracic Surgery

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“…13,22–25 Other studies that reported nonlesion risk scores such as the perioperative adult CHD score and the Aristotle score focused on perioperative risk assessment and hence not applicable for risk assessment in ambulatory patients. 26,27 The Seattle heart failure model is a well-validated risk model in patients with acquired heart disease, but its prognostic role in adults with CHD is not well understood. 28 Stefanescu et al 29 tested the prognostic performance of the Seattle heart failure model in adults with CHD and reported that the model can identify patients at an increased risk for 5-year mortality from heart failure.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease

Egbe

Miranda

Jain

et al. 2023

Circ: Heart Failure

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BACKGROUND: The prognostic role of the congenital heart disease (CHD) anatomic/physiologic classification has not been systematically studied. The purpose of this study was to determine whether CHD physiologic stage provided improvement in prognostic power (to predict all-cause mortality) beyond conventional clinical risk models. METHODS: Retrospective study of adults with CHD at the Mayo Clinic (2003–2019). The CHD physiologic stage was assessed at baseline and 36 (24–48) months, and patients were classified into stages A to D at these time points. Clinical stability (remaining in the same stage), clinical improvement (moving to less advanced stage), and clinical deterioration (moving to more advanced stage) were determined at 36 months. We defined conventional clinical risk indices as age/sex, functional class, comorbidities, cardiac procedures, hepatorenal dysfunction, and ventricular/valvular dysfunction. RESULTS: Of 5321 patients, 1649 (31%), 1968 (37%), 1224 (23%), and 480 (9%) were in stages A, B, C, and D at baseline. Of 5321 patients, 4588 (86%) also had assessments at 36 months, and of these patients, 3347 (73%), 386 (8%), and 855 (19%) had clinical stability, deterioration, and improvement, respectively. Patients with clinical improvement were more likely to have undergone cardiac procedures between both assessments. Both baseline CHD physiologic stage (hazard ratio, 1.13 [95% CI, 1.09–1.17]; P <0.001, per unit increase in stage) and change in CHD physiologic stage (hazard ratio, 1.46 [95% CI, 1.32–1.61]; P =0.007, per unit increase in stage) were associated with mortality after adjustments for conventional risk indices and provided incremental improvement in prognostic power beyond conventional clinical risk models as evidence by an increase in C statistic from 0.702 (0.681–0.724) to 0.769 (0.754–0.787). CONCLUSIONS: The CHD physiologic stage can potentially be used for risk stratification, as well as to monitor disease progression and response to therapy.

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Enhanced Assessment of Perioperative Mortality Risk in Adults With Congenital Heart Disease

Cited by 25 publications

References 18 publications

Repair of Aortic Regurgitation in Young Adults: Sooner Rather Than Later

Repair of Aortic Regurgitation in Young Adults: Sooner Rather Than Later

The Fontan procedure is no longer the last operation

Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease

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