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Better preoperative exercise function is associated with shorter hospital stay after paediatric pulmonary valve replacement or conduit revision

Part of: Tetralogy of Fallot (TOF) Surgery

Published online by Cambridge University Press:  04 March 2021

Naomi Gauthier Open the ORCID record for Naomi Gauthier [Opens in a new window] ,
Angelika Muter ,
Jonathan Rhodes ,
Kimberlee Gauvreau  and
Meena Nathan
Naomi Gauthier*
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Angelika Muter
Affiliation:
Department of Cardiovascular Surgery, Boston Children’s Hospital, Boston, MA, USA
Jonathan Rhodes
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Kimberlee Gauvreau
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Meena Nathan
Affiliation:
Department of Cardiovascular Surgery, Boston Children’s Hospital, Boston, MA, USA Department of Surgery, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: N. Gauthier, MD, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue BCH 3215, Boston, MA, 02115, USA. Tel: +1 617 355 6249; Fax: +1 617 739 6282. E-mail: naomi.gauthier@cardio.chboston.org
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Abstract

Exercise capacity is a modifiable factor in patients with CHD that has been related to surgical outcomes in adults. We hypothesised that this was true for children undergoing surgical pulmonary valve replacement; therefore, the relationship of preoperative percent predicted peak oxygen consumption to surgical outcomes as measured by total hospital length of stay was explored.

Methods:

Single centre retrospective cohort study of patients aged 8–18 years who underwent surgical pulmonary valve replacement. The primary predictor was preoperative percent predicted peak oxygen consumption, and primary outcome was total hospital length of stay. Clinical, imaging, and cardiopulmonary exercise test data were reviewed and compared to total hospital length of stay. Cox proportional hazards regression was used to examine the association between total hospital length of stay and percent predicted peak oxygen consumption.

Results:

Three-hundred and seventy patients undergoing pulmonary valve replacement/conduit change between 2003 and 2017 at Boston Children’s Hospital were identified. Ninety had preoperative cardiopulmonary exercise tests within 6 months of surgery. Exclusion for inadequate exercise data (n = 3) and imaging data (n = 1) left 86 patients for review. Patients with percent predicted peak oxygen consumption ≥ 70% (n = 46, 53%) had shorter total hospital length of stay (4.4 days) than the 40 with percent predicted peak oxygen consumption <70% (5.4 days, p = 0.007). Median percent predicted peak oxygen consumption increased over sequential surgical eras (p < 0.001), but total hospital length of stay did not correlate with surgical era, preoperative left ventricular function, or preoperative right ventricular dilation.

Conclusion:

Children undergoing surgical pulmonary valve replacement with better preoperative exercise capacity had shorter total hospital length of stay. Exercise capacity is a potentially modifiable factor prior to and after pulmonary valve replacement. Until more patients systematically undergo cardiopulmonary exercise tests, the full impact of optimisation of exercise capacity will not be known.

Keywords

Exercisecongenital heartoutcomespulmonary valve replacementtetralogy of Fallot
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1636 - 1643
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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