What Can the Database Tell Us About Reoperation?
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1 AATS/STS Congenital Heart Disease Postgraduate Symposium May 5, 2013 What Can the Database Tell Us About Reoperation? Jeffrey P. Jacobs, M.D. All Children s Hospital Johns Hopkins Medicine The Congenital Heart Institute of Florida (CHIF) Saint Petersburg, Tampa, and Orlando, Florida, United States of America
2 AATS/STS Congenital Heart Disease Postgraduate Symposium May 5, 2013 What Can the Database Tell Us About Reoperation? Jeffrey P. Jacobs, M.D. All Children s Hospital Johns Hopkins Medicine The Congenital Heart Institute of Florida (CHIF) Saint Petersburg, Tampa, and Orlando, Florida, United States of America
3 Disclosure 1. Chair of the STS Congenital Heart Surgery Database Taskforce 2. Chair of the STS Database Task Force on Longitudinal Follow-up and Linked Registries 3. Chair of the STS Database Public Reporting Task Force
4 Q48. In the STS Congenital Heart Surgery Database, what is the most common reoperation in adults with congenital heart disease? a. Arrhythmia surgery - atrial, Surgical Ablation b. Conduit reoperation c. Fontan revision or conversion (Re-do Fontan) d. Pacemaker procedure e. Valve replacement, Pulmonic (PVR)
5 JDearani JA, Connolly HM, Martinez R, Fontanet H, Webb GD. Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond. In 2007 Supplement to Cardiology in the Young: Controversies and Challenges Facing Paediatric Cardiovascular Practitioners and their Patients, Anderson RH, Jacobs JP, and Wernovsky G, editors. Cardiology in the Young 2007 Sep;17 Suppl 2:87-96.
6 The Report of the 2010 STS Congenital Heart Surgery Practice and Manpower Survey undertaken by the Society of Thoracic Surgeons Workforce on Congenital Heart Surgery 125 centers in the United States of America perform pediatric and congenital heart surgery 8 centers in Canada perform pediatric and congenital heart surgery Jacobs ML, Daniel M, Mavroudis C, Morales DLS, Jacobs JP, Fraser CD, Turek JW, Mayer JE, Tchervenkov C, Conte JV. Report of the 2010 Society of Thoracic Surgeons Congenital Heart Surgery Practice and Manpower Survey. The Annals of Thoracic Surgery, 2011;92:762 9, August 2011.
7 STS Database Penetrance in USA The aggregate report from Fall 2012 Harvest of the STS Congenital Heart Surgery Database includes data from: 108 Congenital Heart Surgery hospitals in North America, 105 in the United States of America 3 in Canada.
8 STS Database Penetrance in USA STS Congenital Heart Surgery Database: 84% Programs in USA STS Congenital Heart Surgery Database: >90% of Operations in USA
9 Growth in the STS Congenital Heart Surgery Database Participating Centers Participating Centers Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI. Executive Summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database - Seventeenth Harvest (July 1, 2008 June 30, 2012). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Fall 2012 Harvest.
10 Growth in the STS Congenital Heart Surgery Database Operations per averaged 4 year data collection cycle Operations Operations Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI. Executive Summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database - Seventeenth Harvest (July 1, 2008 June 30, 2012). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Fall 2012 Harvest.
11 Growth in the STS Congenital Heart Surgery Database Cumulative operations over time Cumulative Operations Cumulative Operations Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI. Executive Summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database - Seventeenth Harvest (July 1, 2008 June 30, 2012). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Fall 2012 Harvest.
12 Jacobs JP, Maruszewski B, Kurosawa H, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI, Walters H 3rd, Stellin G, Ebels T, Tsang VT, Elliott MJ, Murakami A, Sano S, Mayer JE Jr, Edwards FH, Quintessenza JA. Congenital heart surgery databases around the world: do we need a global database? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2010;13(1):3-19.PMID:
13
14 The Japan Congenital Cardiovascular Surgery Database (JCCVSD) Jacobs JP, Maruszewski B, Kurosawa H, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI, Walters H 3rd, Stellin G, Ebels T, Tsang VT, Elliott MJ, Murakami A, Sano S, Mayer JE Jr, Edwards FH, Quintessenza JA. Congenital heart surgery databases around the world: do we need a global database? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2010;13(1):3-19.PMID:
15 JDearani JA, Connolly HM, Martinez R, Fontanet H, Webb GD. Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond. In 2007 Supplement to Cardiology in the Young: Controversies and Challenges Facing Paediatric Cardiovascular Practitioners and their Patients, Anderson RH, Jacobs JP, and Wernovsky G, editors. Cardiology in the Young 2007 Sep;17 Suppl 2:87-96.
16 The STS-CHSD was queried for all index operations in the four year analytic window of , inclusive. Operations were excluded if: 1. STAT Mortality Category was not available 2. Key data elements were missing: Procedure Mortality status at hospital discharge Number of prior CPB cardiothoracic operations 3. Patient was less than or equal to 2,500g undergoing PDA ligation as their primary procedure.
17 As a surrogate for reoperation, we stratified operations in the STS-CHSD by the variable: Number of Prior CPB Cardiothoracic Operations.
18 This analysis is based on 92,603 index cardiac operations performed in the four year analytic window of , inclusive, 61,930 index cardiac operations with zero prior CPB cardiothoracic operations and 30,673 index cardiac operations with one or more prior CPB cardiothoracic operations.
19
20 Mortality Stratified by Number of Prior CPB Cardiothoracic Operations 6 5 Mortality or more Mortality
21 Mean Postoperative Length of Stay Stratified by Number of Prior CPB Cardiothoracic Operations Mean PLOS or more Mean PLOS
22 Procedure (All Patients) Bidirectional cavopulmonary anastomosis Number Mortality Mortality (%) % Valve replacement, Pulmonic (PVR) % Fontan, TCPC, External conduit, Fenestrated % Conduit reoperation % Pacemaker procedure % Fontan, TCPC, External conduit, Nonfenestrated Pacemaker implantation, Permanent % %
23 Procedure (All Patients) Bidirectional cavopulmonary anastomosis Number Mortality Mortality (%) % Valve replacement, Pulmonic (PVR) % Fontan, TCPC, External conduit, Fenestrated % Conduit reoperation % Pacemaker procedure % Fontan, TCPC, External conduit, Nonfenestrated Pacemaker implantation, Permanent % %
24 Procedure (Neonates) Arterial switch operation (ASO) Number Mortality Mortality (%) % Shunt, Systemic to pulmonary, Modified Blalock-Taussig Shunt % Norwood procedure % TAPVC repair % Arterial switch and VSD repair % Aortic arch repair % PA banding (PAB) %
25 Procedure (Neonates) Arterial switch operation (ASO) Number Mortality Mortality (%) % Shunt, Systemic to pulmonary, Modified Blalock-Taussig Shunt % Norwood procedure % TAPVC repair % Arterial switch and VSD repair % Aortic arch repair % PA banding (PAB) %
26 Procedure (Infants) Bidirectional cavopulmonary anastomosis (BDCPA) (bidirectional Glenn) Superior Cavopulmonary anastomosis(es) + PA reconstruction Bilateral bidirectional cavopulmonary anastomosis (BBDCPA) (bilateral bidirectional Glenn) Number Mortality Mortality (%) % % % HemiFontan % TOF repair, Ventriculotomy, Transanular patch %
27 Procedure (Children) Fontan, TCPC, External conduit, Fenestrated Number Mortality Mortality (%) % Conduit reoperation % Fontan, TCPC, External conduit, Nonfenestrated % Valve replacement, Pulmonic (PVR) % Pacemaker procedure % Fontan, TCPC, Lateral tunnel, Fenestrated Pacemaker implantation, Permanent % %
28 Procedure (Adults) Valve replacement, Pulmonic (PVR) Number Mortality Mortality (%) % Pacemaker procedure % Conduit reoperation % Arrhythmia surgery - atrial, Surgical Ablation % Fontan revision or conversion (Re-do Fontan) Pacemaker implantation, Permanent % % Conduit placement, RV to PA %
29 Procedure (Adults) Valve replacement, Pulmonic (PVR) Number Mortality Mortality (%) % Pacemaker procedure % Conduit reoperation % Arrhythmia surgery - atrial, Surgical Ablation % Fontan revision or conversion (Re-do Fontan) Pacemaker implantation, Permanent % % Conduit placement, RV to PA %
30 Science tells us what we can do; Guidelines what we should do; & Registries what we are actually doing.
31 Q48. In the STS Congenital Heart Surgery Database, what is the most common reoperation in adults with congenital heart disease? a. Arrhythmia surgery - atrial, Surgical Ablation b. Conduit reoperation c. Fontan revision or conversion (Re-do Fontan) d. Pacemaker procedure e. Valve replacement, Pulmonic (PVR)
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