Author + information
- Joshua Kovacha,b,
- Trevor L. Birkeya,b,
- Jennifer E. Dixona,b,
- Roni Jacobsena,b,
- Pippa Simpsona,b,
- Melodee Nugenta,b,
- Ke Yana,b and
- Salil Gindea,b
Background: Adults with congenital heart disease (ACHD) often require repeat cardiothoracic surgery, which can result in significant morbidity and mortality. Currently there are few preoperative risk assessment tools available. In the general adult population, preoperative cardiopulmonary exercise testing (CPET) has predictive value for postoperative morbidity and mortality after major non-cardiac surgery. The utility of CPET for risk assessment in ACHD patients referred for surgery has not been evaluated.
Methods: Retrospective chart review was conducted on 78 ACHD patients who participated in CPET less than 12 months prior to major cardiothoracic surgery at Children's Hospital of Wisconsin between January, 2005 and December, 2015. Minimally invasive procedures, single ventricle physiology, and heart transplant patients were excluded. Demographic information, CPET results, and perioperative surgical data were collected for each patient and analyzed. Spearman correlations (rho) are given.
Results: The median age of the study population was 25 years (range 17-58 years), and 55% were males. Postoperative length of stay correlated with increased VE/VCO2 slope (rho = 0.27, p = 0.039), while prolonged intubation was associated with decreased exercise time (rho = −0.34, p = 0.003), decreased heart rate response (rho = −0.30, p = 0.009), and decreased peak VO2 (rho = −0.26, p = 0.049). Postoperative complications were documented in 56% of patients, including arrhythmia, persistent pleural effusion, infection, and prolonged bleeding. There were trends noted between postoperative complications and some measurements of exercise capacity, such as peak metabolic equivalent of task, respiratory quotient, and heart rate response, but these did not meet statistical significance.
Conclusions: In a relatively young ACHD cohort, measures of exercise capacity significantly correlated with postoperative length of stay and duration of ventilation. A larger study is required to further define the relationship between exercise capacity and postoperative morbidity in ACHD patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Redefining the “F” Word
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1270-015
- 2017 American College of Cardiology Foundation