title: Adult congenital heart disease: intensive care management and outcome prediction.
abstract: OBJECTIVE
  Improved patient survival and increasingly complex surgery have expanded the requirement for specialist care for patients with adult congenital heart disease (ACHD). Despite the recent publications of management guidelines for ACHD, data concerning optimal patterns of care in the peri-operative/critical care period of this challenging population are sparse. The aims of the current study were to therefore to determine the pattern of intensive care unit (ICU) management, resource utilisation and predictors of mortality in critically ill ACHD patients.
  
  
  METHODS
  Data were collected prospectively for patients with ACHD stratified for complexity of disease admitted to the ICU of a tertiary cardiothoracic centre (1997-2002). Multivariate analysis of pre-operative indices as predictors of mortality was performed. Of 342 ACHD admissions (total mortality 4.4%, simple 0%, moderate/complex 10.6%), the requirement for specialist investigations and interventions was high, reflected in ICU admission costs per patient (simple $5391+/-130, moderate $13218+/-261, complex $30074+/-689). Standard severity of illness scoring systems did not accurately predict mortality; however, abnormal pre-operative thyroid function (p=0.0048), creatinine (p=0.0032) and bilirubin (p=0.0021) were highly predictive of mortality.
  
  
  CONCLUSIONS
  Peri-operative mortality in patients with ACHD is low overall but varies with disease complexity. Such patients have a high requirement for specialist ICU investigation/intervention. Although standard severity of illness scoring is unhelpful, simple pre-operative parameters may predict peri-operative mortality. These findings reflect the requirement for specialist care, and have implications for planning service provision, training and operative consent in ACHD patients.
authors.affiliation: Department of Adult Congenital Heart Disease, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
authors.forename: Sian Isobel
authors.initials: SI
authors.lastname: Jaggar
authors.forename: Simon
authors.initials: S
authors.lastname: Jordan
authors.forename: Sarah
authors.initials: S
authors.lastname: Trenfield
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khan
authors.forename: Babulal
authors.initials: B
authors.lastname: Sethia
authors.forename: Darryl
authors.initials: D
authors.lastname: Shore
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Evans
mesh_terms: D018806:APACHE; D000328:Adult; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000601:surgery / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies