Abstract 18313: Predictors of Death or Extracorporeal Membrane Oxygenation Support After Surgery for Adult Congenital Heart Disease
Introduction: Adults with congenital heart disease (ACHD) who undergo cardiac surgery are at risk for poor outcomes, including death and extracorporeal membrane oxygenation support (ECMO). Prior studies have demonstrated risk factors for mortality, but have not differentiated between death despite ECMO usage and death without ECMO support. Furthermore, risk factors for ECMO support and death without ECMO have not been described.
Hypothesis: Patients who die or require ECMO after ACHD surgery will have identifiable risk factors.
Methods: All adults (≥ 18 years) undergoing congenital heart surgery in the Pediatric Health Information System database between the years of 2003-2014 were included. Patients were classified as ECMO-free survival, requiring ECMO support or death without ECMO support. Multivariate models were constructed examining death and ECMO support as individual and composite outcomes.
Results: A total of 5724 adult patients underwent cardiac surgery with 66 patients requiring ECMO and 81 dying without ECMO support. Of the 66 ECMO patients, 42 (64%) died. Pre-operative variables including older age, longer pre-operative length of stay, higher RACHS-1 score, higher number of comorbidities, and single ventricle anatomy were associated with the composite outcome of ECMO or death. Post-operative variables including acute renal failure, stroke, liver failure, post-operative hemorrhage, cardiac arrest, GI hemorrhage, paroxysmal ventricular tachycardia (VT) and secondary pulmonary hypertension were also associated with increased risk of ECMO or death. In multinomial models, age, higher number of comorbidities and GI hemorrhage were not associated with increased risk of ECMO support but were associated with death without ECMO. In contrast, paroxysmal VT and secondary pulmonary hypertension were associated with increased risk of ECMO but not death without ECMO. All other variables remained associated with both outcomes.
Conclusions: There are similar but separate risk factors for ECMO support and death without ECMO in adults undergoing congenital heart surgery in pediatric hospitals. Both pre-operative and post-operative risk factors should be considered when counseling and caring for these patients.
Author Disclosures: S.J. Dolgner: None. T. Chan: None. E.V. Krieger: None. J. Wilkes: None. S.L. Bratton: None. R.R. Thiagarajan: None. C.S. Barrett: None.
- © 2016 by American Heart Association, Inc.