A new long-term study published in the Annals of Thoracic Surgery has found that while the Residual Lesion Score (RLS) does not predict late death or heart transplantation, it does significantly predict the need for future surgeries or interventions.
Researchers analyzed data from 1,027 infants who underwent one of five major congenital heart operations between 2000 and 2012, including repairs for complete atrioventricular septal defect, tetralogy of Fallot (TOF), dextro-transposition of the great arteries, single ventricle (Norwood procedure), and coarctation of the aorta with a ventricular septal defect. All patients survived hospital discharge, and the cohort was followed for a median of 15 years.
Each patient was assigned an RLS based on clinical and echocardiographic findings post-surgery, i.e., RLS 1 for no or trivial residual lesions, RLS 2 for minor residual lesions, and RLS 3 for major residual lesions or those requiring in-hospital reintervention.
The key finding was that RLS did not influence survival. The freedom from death or heart transplant was 93.7% at 15 years, regardless of the RLS category. However, patients with an RLS of 3 were twice as likely to require reoperations or other cardiac interventions later in life (hazard ratio 2.02). Other factors associated with a higher reintervention risk included younger age, intraoperative revisions, and specific surgeries, such as TOF with pulmonary stenosis repair and the arterial switch operation.
These findings reinforce the value of RLS as a practical tool for predicting future healthcare needs, even if it does not indicate mortality risk. Clinicians may use RLS to identify patients who need closer follow-up and possible preventive care.