Cardiopulmonary Exercise Testing for Surgical Risk Stratification in Adults with Congenital Heart Disease.

Birkey T; Dixon J; Jacobsen R; Ginde S; Nugent M; Yan K; Simpson P; Kovach J

Pediatric Cardiology. 39(7):1468-1475, 2018 Oct.

Adult congenital heart disease (ACHD) patients often require repeat
cardiothoracic surgery, which may result in significant morbidity and
mortality. Currently, there are few pre-operative risk assessment tools
available. In the general adult population, pre-operative cardiopulmonary
exercise testing (CPET) has a predictive value for post-operative
morbidity and mortality following major non-cardiac surgery. The utility
of CPET for risk assessment in ACHD patients requiring cardiothoracic
surgery has not been evaluated. Retrospective chart review was conducted
on 75 ACHD patients who underwent CPET less than 12 months prior to major
cardiothoracic surgery at Children’s Hospital of Wisconsin. Minimally
invasive procedures, cardiomyopathy, acquired heart disease, single
ventricle physiology, and heart transplant patients were excluded.
Demographic information, CPET results, and peri-operative surgical data
were collected. The study population was 56% male with a median age of 25
years (17-58). Prolonged post-operative length of stay correlated with
increased ventilatory efficiency slope (VE/[Formula: see text] slope) (P =
0.007). Prolonged intubation time correlated with decreased peak HR (P =
0.008), decreased exercise time (P = 0.002), decreased heart rate response
(P = 0.008) and decreased relative peak oxygen consumption (P = 0.034).
Post-operative complications were documented in 59% of patients. While
trends were noted between post-operative complications and some
measurements of exercise capacity, none met statistical significance.
Future studies may further define the relationship between exercise
capacity and post-operative morbidity in ACHD patients.