Significant ICU respiratory morbidity in postoperative patients with adult congenital heart disease

Introduction

Increasing numbers of patients with congenital heart disease now survive to adulthood, requiring repeated surgical and cardiological interventions that necessitate ICU admission [1]. There are little data in the literature regarding the ICU morbidity and mortality in this patient population. We therefore evaluated the ICU respiratory morbidity in patients with adult congenital heart disease (ACHD).

Methods

A database (Medicus, High Wycombe, UK) was interrogated for all patients admitted to the ICU of a cardiothoracic tertiary referral centre during the period January 1997–2002 with ACHD. Classification of ACHD complexity was according to the modified Canadian Consensus Conference criteria. Patient demographics, details of any surgical procedure and mortality were extracted. Analysis of respiratory investigations and interventions (Fig. 1) was performed.

Figure 1

Prolonged vent, prolonged ventilation > 72 hours; US+pl drainage, ultrasound and pleural drainage; CT thorax, computerised tomography thorax; ext to NIV, extubation to non-invasive ventilation and tracheostomy; ASD, atrial septal defect; VSD, ventricular septal defect; AVSD, atrioventricular septal defect; TOF, Tetralogy of Fallot; TGA, transposition of the great arteries.

Results

Over the accounting period 342 patients with ACHD were admitted (6.4% of total ICU admissions), of which 305 (90%) were following cardiac surgery. Perioperative mortality was 3.3%. Patients with simple ACHD had zero mortality, a low requirement for respiratory investigations and interventions (Fig. 1a). Patients with moderately complex and complex ACHD had a higher mortality (10.6%) and significantly higher requirement for respiratory investigations and interventions (Fig. 1b).

Conclusion

Patients undergoing surgery for complex ACHD have a significant requirement for respiratory investigations and interventions. As the case mix is changing, with more complex patients requiring intervention in adulthood, this has implications for future planning of ICU ACHD care.