The Association Between Residual Lesion Score and Long-term Outcomes of Congenital Cardiac Operations

Abstract

Background: This study sought to investigate the impact of the residual lesion score (RLS) on the long-term outcomes of 5 common congenital heart operations.

Methods: All infants who underwent definitive operation for complete atrioventricular septal defect, tetralogy of Fallot (TOF), dextro-transposition of the great arteries, single ventricle (Norwood procedure), and coarctation of the aorta with ventricular septal defect between 2000 and 2012 and who survived until discharge were studied. RLS scores (1, no or trivial; 2, minor; 3, major or in-hospital reinterventions or reoperations for such lesions) were assigned on the basis of postrepair clinical and echocardiographic evaluation. The time to events was summarized using the Kaplan-Meier survival method and competing risk models.

Results: A total of 1027 patients were included (213 atrioventricular septal defects, 358 TOFs, 308 dextro-transpositions of the great arteries, 127 single ventricles, and 21 coarctations of the aorta with ventricular septal defects), with a median follow-up time of 15 years (interquartile range, 11-18.4 years). Overall, 227 patients (22.1%) had an RLS of 1, 556 patients (54.1%) had an RLS of 2, and 244 patients (23.8%) had an RLS of 3. Freedom from late death or heart transplantation was 93.7% at 15 years. The RLS was not associated with late death or transplantation. Male sex, TOF, and arterial switch operation had the lowest risk for late death or transplantation. Late reinterventions or reoperations were present in 14.5% at 15 years. Younger age, TOF with pulmonary stenosis repair, arterial switch operation, an RLS of 3 (hazard ratio, 2.02; 95% CI, 1.17-3.51; P = .012), intraoperative surgical revision, and in-hospital reintervention or reoperation were associated with late reintervention or reoperation.

Conclusions: The RLS does not predict late mortality but predicts late reintervention or reoperation after congenital cardiac disease repair and can be used to target at-risk patients for follow-up.