For a study, researchers sought to determine the long-term outcomes of transplant-free hospital discharge survivors who needed predischarge reinterventions following congenital heart surgery.

From January 2011 to December 2019, data from patients who required predischarge reinterventions in the anatomic region of repair following congenital heart surgery and lived to hospital discharge at a quaternary referral center were evaluated retrospectively. To determine the degree of persistent remaining lesions upon discharge, previously established echocardiographic criteria were applied (Grade 1, no residua; Grade 2, minor residua; and Grade 3, major residua). Postdischarge (late) death or a transplant and unscheduled reintervention were among the outcomes. The associations between predischarge residual lesion severity and outcomes were examined using Cox or competing risk models, with all considered baseline patient characteristics, case complexity, and preoperative risk factors. 

At a median follow-up of 3.0 years, there were 58 (14.2%) post-discharge deaths or transplants and 208 (51.0%) late reinterventions among the 408 patients who matched entrance criteria (IQR: 1.1-6.8 years). Greater predischarge residual lesion severity was linked to worse transplant-free survival and independence from reintervention (both P<0.05). Compared to Grade 1 patients, Grade 3 patients had a higher risk of postdischarge death or transplant (HR: 4.8; 95% CI: 2.0-11; P<0.001) and late reintervention (subdistribution HR: 2.1; 95% CI: 1.4-3.1; P<0.001).

Those with persisting large residua have considerably inferior long-term outcomes among transplant-free survivors who require predischarge reinterventions following congenital heart surgery. Therefore, these high-risk patients require careful monitoring.

Reference: jacc.org/doi/10.1016/j.jacc.2022.04.027