Nearly 17% of US adults with congenital heart disease are at a high risk for operative mortality and critical postoperative complications after redo cardiac surgery. This increased risk emphasizes the importance of a national risk assessment to help patients with congenital heart disease and clinicians make key decisions.
To validate existing predictive models in a national database, Elaine M. Griffeth, MD, a resident in the combined General and Thoracic Surgery Program and an assistant professor in Health Services Research at Mayo Clinic in Rochester, Minnesota, and colleagues investigated 11,337 cases from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD). They included adults with congenital heart disease who underwent cardiac reoperations from 2017 to 2023.
The researchers used a combination of machine learning and conventional statistical methods to examine the risk for a composite of operative mortality and major postoperative morbidity. This outcome included mechanical circulatory support, dialysis, unplanned noncardiac reoperation, neurologic deficit, and cardiac arrest.
Griffeth presented the results at the Society of Thoracic Surgeons (STS) 2026 Annual Meeting.
Predictors of Postoperative Risk
More than 1 million adults in the US are living with congenital heart disease, the most common type of birth defect worldwide, according to the American College of Cardiology. The CDC reports that nearly 1 in 100 babies are born with some sort of structural heart defect, affecting about 40,000 infants per year.
Many people with congenital heart disease who underwent surgery as children require additional surgeries as adults, Griffeth and colleagues noted. For example, a study published in Circulation showed that one fifth of young adults with congenital heart disease required cardiovascular surgery during a 15-year period. In 40% of these patients, the surgery was a reoperation.
However, Griffeth and colleagues said current tools used to estimate operative risk are geared toward the broader adult population with cardiovascular disease and therefore make it challenging for surgeons to measure risk factors that pertain specifically to patients with congenital heart disease.
In their analysis, Griffeth and colleagues found that 16.7% of adults with congenital heart disease were at high risk for operative mortality and critical postoperative complications after redo cardiac surgery. They identified 15 factors that helped predict postoperative risk, including:
- Age
- Prior cardiovascular operations
- Requiring surgery in an urgent/emergent timeframe
- Preoperative ventricular ejection fraction
- Preoperative creatinine
- Heart failure
“This list is consistent with our prior work at Mayo Clinic’s high-volume adult congenital cardiac surgery practice, as well as other studies evaluating risk for operative mortality alone,” said study researcher Joseph A. Dearani, MD, director of pediatric and adult congenital heart surgery at Mayo Clinic and a professor of surgery in the Mayo Clinic College of Medicine.
‘A Spectrum of Severity’
Adults with congenital heart disease who have one ventricle, which is a key marker for long-term risk, present a particular challenge, the researchers noted.
“Patients with a single ventricle face a multistage surgical palliation strategy as children that, over time, results in longstanding impacts on hemodynamics, physiology, and cardiac rhythm,” Griffeth told Medscape Medical News. “As adults, their reoperations are performed in the setting of many prior cardiac operations, and they experience associated scar tissue and hepatic and renal dysfunction.”
Griffeth and Dearani added that single-ventricle status is not often depicted in the ACSD. Therefore, the researchers used similar analytical techniques tailored to the ACSD to create a risk model.
Due to treatment advances, people with congenital heart disease are living longer, with approximately 90% of children born with the disease living into adulthood, according to the American Academy of Pediatrics.
However, Griffeth added that “a spectrum of severity exists in congenital heart disease; therefore, survival and associated complications with the disease vary by severity. This underscores the need to further analysis of the ACSD to develop clinically applicable and accurate risk prediction models for morbidity and mortality for patients with congenital heart disease.”
Griffeth and Dearani reported having no financial disclosures.
Martta Kelly is a medical journalist living in the New York metropolitan area.
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