Browsing by Author "Adachi, Iki"

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    Impact of Major Residual Lesions on Outcomes after Surgery for Congenital Heart Disease
    (Elsevier, 2021) Nathan, Meena; Levine, Jami C.; Van Rompay, Maria I.; Lambert, Linda M.; Trachtenberg, Felicia L.; Colan, Steven D.; Adachi, Iki; Anderson, Brett R.; Bacha, Emile A.; Eckhauser, Aaron; Gaynor, J. William; Graham, Eric M.; Goot, Benjamin; Jacobs, Jeffrey P.; John, Rija; Kaltman, Jonathan R.; Kanter, Kirk R.; Mery, Carlos M.; Minich, L. LuAnn; Ohye, Richard; Overman, David; Pizarro, Christian; Raghuveer, Geetha; Schamberger, Marcus S.; Schwartz, Steven M.; Narasimhan, Shanthi L.; Taylor, Michael D.; Wang, Ke; Newburger, Jane W.; Pediatric Heart Network Investigators; Pediatrics, School of Medicine
    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 post-operative 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.