Noninvasive screening for surgery in adults with simple shunting congenital heart disease

The aim of this study was to use non-invasive parameters to assess eligibility to undergo surgery in patients with adult congenital heart disease (CHD).

This is a single-center retrospective study that collected patients’ demographic data, right heart catheterization, complete blood count, N-terminal pro-brain natriuretic peptide (NT-proBNP), arterial blood gas, pulmonary function test (PFT), cardiopulmonary exercise testing (CPET), and echocardiographic parameters. Surgical eligibility of patients was evaluated based on hemodynamic parameters, specifically pulmonary vascular resistance (PVR) < 4.6 WU and pulmonary vascular resistance index (PVRI) < 8 WU ▪ m². Univariate analysis was employed to compare baseline parameters between the two patient groups. Independent predictive factors were determined using binary logistic regression analysis.

A total of 81 patients with adult CHD were included in the study, with 34 qualifying for surgery and 47 not meeting the criteria for surgery. The group eligible for surgery exhibited superior hemodynamics, higher oxygen partial pressure, and better diffusion capacity compared to the non-eligible group. Echocardiographic findings revealed lower systolic pulmonary artery pressure (SPAP) in the eligible group (79.23 ± 23.56 vs. 98.91 ± 20.23 mmHg, p = 0.00), higher tricuspid annular plane systolic excursion (TAPSE) (2.10 (1.88, 2.50) vs. 1.81 (1.70, 2.01) cm, p = 0.001), and increased TAPSE/SPAP ratio (0.32 ± 0.14 vs. 0.20 ± 0.59 mm/mmHg, p = 0.00). TAPSE/SPAP emerged as an independent predictor, with an area under the receiver operating characteristic (ROC) curve of 0.81 (95% CI: 0.70–0.92, p < 0.01).

The echocardiographic parameter TAPSE/SPAP may be a valuable index to evaluate whether patients with coronary artery disease are suitable for surgery.