Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease: A Routine with a Reason?

Irsa Shoiab, David A. Danford, Ling Li, Ibrahim Abdullah, James M. Hammel, Shelby Kutty

Research output: Contribution to journalArticle

Abstract

Background Predischarge (pre-d/c) transthoracic echocardiography (TTE) is routine after surgery for congenital heart disease, but how it affects clinical care is unknown. The aim of this study was to test the hypothesis that pre-d/c TTE frequently reveals findings associated with short-term clinical course through a systematic review of findings on pre-d/c TTE and clinical events that followed. Methods Clinical outcomes of mortality, hospitalization, catheterization, and surgery at 1 year were examined for pediatric patients undergoing pre-d/c TTE between June 2010 and June 2012. Using logistic regression, a multivariate model was generated associating clinical, pre-d/c transthoracic echocardiographic, and demographic variables with unplanned postdischarge cardiac events (UCEs) within 1 year. Results Of 462 patients who underwent pre-d/c TTE, there were 265 male patients (57%) and 197 female patients (43%); the median age was 0.8 years (range, 0-33 years). Two hundred thirty-seven patients (51%) had findings (valve regurgitation, hemodynamic obstruction, ventricular dysfunction, unintended shunt, or pericardial effusion) on pre-d/c TTE, 57 of which were of more than mild severity. Agreement between pre-d/c TTE and postoperative transesophageal echocardiographic findings was only fair to moderate (κ = 0.27-0.43). Sixty-four patients (14%) had UCEs. Univariate analysis revealed that UCE were more frequent in patients with diagnoses and surgical procedures of high complexity. After accounting for these confounding nonechocardiographic variables, pre-d/c transthoracic echocardiographic findings, specifically valve regurgitation of more than mild severity, and ventricular dysfunction and obstructions of any severity were independently associated with UCEs (odds ratios, 1.90, 1.99, and 1.85, respectively). Conclusions Findings on pre-d/c TTE are frequent, commonly discordant with postoperative transesophageal echocardiographic results, and associated with adverse clinical events after surgery for congenital heart disease. These data would strongly support the practice of pre-d/c TTE after surgery for congenital heart disease.

Original languageEnglish (US)
Article number3414
Pages (from-to)1030-1035
Number of pages6
JournalJournal of the American Society of Echocardiography
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Fingerprint

Dilatation and Curettage
Echocardiography
Heart Diseases
Ventricular Dysfunction
Confounding Factors (Epidemiology)
Pericardial Effusion
Catheterization
Curriculum
Hospitalization
Logistic Models
Hemodynamics
Odds Ratio
Demography

Keywords

  • Congenital heart disease
  • Outcomes after surgery
  • Predismissal echocardiography
  • Two-dimensional echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease : A Routine with a Reason? / Shoiab, Irsa; Danford, David A.; Li, Ling; Abdullah, Ibrahim; Hammel, James M.; Kutty, Shelby.

In: Journal of the American Society of Echocardiography, Vol. 28, No. 9, 3414, 01.09.2015, p. 1030-1035.

Research output: Contribution to journalArticle

Shoiab, Irsa ; Danford, David A. ; Li, Ling ; Abdullah, Ibrahim ; Hammel, James M. ; Kutty, Shelby. / Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease : A Routine with a Reason?. In: Journal of the American Society of Echocardiography. 2015 ; Vol. 28, No. 9. pp. 1030-1035.
@article{09ae085d6cfe44eb8fe21e2a1ed1a058,
title = "Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease: A Routine with a Reason?",
abstract = "Background Predischarge (pre-d/c) transthoracic echocardiography (TTE) is routine after surgery for congenital heart disease, but how it affects clinical care is unknown. The aim of this study was to test the hypothesis that pre-d/c TTE frequently reveals findings associated with short-term clinical course through a systematic review of findings on pre-d/c TTE and clinical events that followed. Methods Clinical outcomes of mortality, hospitalization, catheterization, and surgery at 1 year were examined for pediatric patients undergoing pre-d/c TTE between June 2010 and June 2012. Using logistic regression, a multivariate model was generated associating clinical, pre-d/c transthoracic echocardiographic, and demographic variables with unplanned postdischarge cardiac events (UCEs) within 1 year. Results Of 462 patients who underwent pre-d/c TTE, there were 265 male patients (57{\%}) and 197 female patients (43{\%}); the median age was 0.8 years (range, 0-33 years). Two hundred thirty-seven patients (51{\%}) had findings (valve regurgitation, hemodynamic obstruction, ventricular dysfunction, unintended shunt, or pericardial effusion) on pre-d/c TTE, 57 of which were of more than mild severity. Agreement between pre-d/c TTE and postoperative transesophageal echocardiographic findings was only fair to moderate (κ = 0.27-0.43). Sixty-four patients (14{\%}) had UCEs. Univariate analysis revealed that UCE were more frequent in patients with diagnoses and surgical procedures of high complexity. After accounting for these confounding nonechocardiographic variables, pre-d/c transthoracic echocardiographic findings, specifically valve regurgitation of more than mild severity, and ventricular dysfunction and obstructions of any severity were independently associated with UCEs (odds ratios, 1.90, 1.99, and 1.85, respectively). Conclusions Findings on pre-d/c TTE are frequent, commonly discordant with postoperative transesophageal echocardiographic results, and associated with adverse clinical events after surgery for congenital heart disease. These data would strongly support the practice of pre-d/c TTE after surgery for congenital heart disease.",
keywords = "Congenital heart disease, Outcomes after surgery, Predismissal echocardiography, Two-dimensional echocardiography",
author = "Irsa Shoiab and Danford, {David A.} and Ling Li and Ibrahim Abdullah and Hammel, {James M.} and Shelby Kutty",
year = "2015",
month = "9",
day = "1",
doi = "10.1016/j.echo.2015.04.009",
language = "English (US)",
volume = "28",
pages = "1030--1035",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "9",

}

TY - JOUR

T1 - Predischarge Transthoracic Echocardiography after Surgery for Congenital Heart Disease

T2 - A Routine with a Reason?

AU - Shoiab, Irsa

AU - Danford, David A.

AU - Li, Ling

AU - Abdullah, Ibrahim

AU - Hammel, James M.

AU - Kutty, Shelby

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background Predischarge (pre-d/c) transthoracic echocardiography (TTE) is routine after surgery for congenital heart disease, but how it affects clinical care is unknown. The aim of this study was to test the hypothesis that pre-d/c TTE frequently reveals findings associated with short-term clinical course through a systematic review of findings on pre-d/c TTE and clinical events that followed. Methods Clinical outcomes of mortality, hospitalization, catheterization, and surgery at 1 year were examined for pediatric patients undergoing pre-d/c TTE between June 2010 and June 2012. Using logistic regression, a multivariate model was generated associating clinical, pre-d/c transthoracic echocardiographic, and demographic variables with unplanned postdischarge cardiac events (UCEs) within 1 year. Results Of 462 patients who underwent pre-d/c TTE, there were 265 male patients (57%) and 197 female patients (43%); the median age was 0.8 years (range, 0-33 years). Two hundred thirty-seven patients (51%) had findings (valve regurgitation, hemodynamic obstruction, ventricular dysfunction, unintended shunt, or pericardial effusion) on pre-d/c TTE, 57 of which were of more than mild severity. Agreement between pre-d/c TTE and postoperative transesophageal echocardiographic findings was only fair to moderate (κ = 0.27-0.43). Sixty-four patients (14%) had UCEs. Univariate analysis revealed that UCE were more frequent in patients with diagnoses and surgical procedures of high complexity. After accounting for these confounding nonechocardiographic variables, pre-d/c transthoracic echocardiographic findings, specifically valve regurgitation of more than mild severity, and ventricular dysfunction and obstructions of any severity were independently associated with UCEs (odds ratios, 1.90, 1.99, and 1.85, respectively). Conclusions Findings on pre-d/c TTE are frequent, commonly discordant with postoperative transesophageal echocardiographic results, and associated with adverse clinical events after surgery for congenital heart disease. These data would strongly support the practice of pre-d/c TTE after surgery for congenital heart disease.

AB - Background Predischarge (pre-d/c) transthoracic echocardiography (TTE) is routine after surgery for congenital heart disease, but how it affects clinical care is unknown. The aim of this study was to test the hypothesis that pre-d/c TTE frequently reveals findings associated with short-term clinical course through a systematic review of findings on pre-d/c TTE and clinical events that followed. Methods Clinical outcomes of mortality, hospitalization, catheterization, and surgery at 1 year were examined for pediatric patients undergoing pre-d/c TTE between June 2010 and June 2012. Using logistic regression, a multivariate model was generated associating clinical, pre-d/c transthoracic echocardiographic, and demographic variables with unplanned postdischarge cardiac events (UCEs) within 1 year. Results Of 462 patients who underwent pre-d/c TTE, there were 265 male patients (57%) and 197 female patients (43%); the median age was 0.8 years (range, 0-33 years). Two hundred thirty-seven patients (51%) had findings (valve regurgitation, hemodynamic obstruction, ventricular dysfunction, unintended shunt, or pericardial effusion) on pre-d/c TTE, 57 of which were of more than mild severity. Agreement between pre-d/c TTE and postoperative transesophageal echocardiographic findings was only fair to moderate (κ = 0.27-0.43). Sixty-four patients (14%) had UCEs. Univariate analysis revealed that UCE were more frequent in patients with diagnoses and surgical procedures of high complexity. After accounting for these confounding nonechocardiographic variables, pre-d/c transthoracic echocardiographic findings, specifically valve regurgitation of more than mild severity, and ventricular dysfunction and obstructions of any severity were independently associated with UCEs (odds ratios, 1.90, 1.99, and 1.85, respectively). Conclusions Findings on pre-d/c TTE are frequent, commonly discordant with postoperative transesophageal echocardiographic results, and associated with adverse clinical events after surgery for congenital heart disease. These data would strongly support the practice of pre-d/c TTE after surgery for congenital heart disease.

KW - Congenital heart disease

KW - Outcomes after surgery

KW - Predismissal echocardiography

KW - Two-dimensional echocardiography

UR - http://www.scopus.com/inward/record.url?scp=84940584406&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940584406&partnerID=8YFLogxK

U2 - 10.1016/j.echo.2015.04.009

DO - 10.1016/j.echo.2015.04.009

M3 - Article

C2 - 25977233

AN - SCOPUS:84940584406

VL - 28

SP - 1030

EP - 1035

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 9

M1 - 3414

ER -