Royal Brompton researchers fill knowledge gap in adult congenital heart disease

Researchers at Royal Brompton Hospital and Imperial College London have created a simple test to determine the risks associated with surgery for adults with congenital heart disease.

Most patients with adult congenital heart disease (ACHD) require long-term treatment and monitoring in specialist hospitals, and many are likely to need one or more operations. Given this is a relatively new group of patients as more and more children are surviving into adulthood, little is known about how to identify those patients who may be at risk of complications after surgery, including, sadly, death (perioperative mortality).

Professor Konstantinos Dimopoulos, consultant cardiologist at Royal Brompton Hospital and professor of practice in ACHD at Imperial College London, and his PhD student Dr Andrew Constantine, created a simple tool to determine perioperative mortality that helps both clinicians and patients make more informed decisions before surgery. They achieved this by putting together a team of experienced physicians and surgeons from Royal Brompton Hospital and the IRCCS Policilinico San Donato in Milan, Italy – a large specialist ACHD centre

The PEACH (PErioperative ACHd) score was developed by studying 1,782 ACHD patients who underwent surgery at Royal Brompton Hospital between 2003 and 2019. The score was then tested for accuracy by using data from a separate group of patients, this time from the IRCCS Policilinico San Donato hospital. The PEACH score reliably predicted the risk of patients, placing them into different categories of risk.

Professor Dimopoulos said: “A tool that can reliably estimate perioperative risk was desperately needed. Determining risk is at the heart of our ACHD practice, and we believe that the PEACH score will prove invaluable to colleagues and patients around the world.”

First author of the paper, Dr Andrew Constantine, research fellow at Royal Brompton and Imperial College London, said: “The PEACH score can be easily calculated in outpatient clinics or at the bedside and can help identify patients who may benefit from alternative treatment, such as percutaneous interventions. These are minimally invasive procedures that can reduce the risk of complications, and have become ever more common in ACHD practice. They are performed using catheters (flexible tubes) inserted into blood vessels to replace valves and close holes in the heart.”

Dr Marco Ranucci, consultant anaesthetist at the IRCCS Policilinico San Donato in Milan, who collaborated with the Royal Brompton team on the research, said: “The PEACH Score is a nice example of collaboration between institutes in different countries. A score such as PEACH, has been long awaited, and we are proud to have contributed.”

The research was published in the Journal of the American College of Cardiology, accompanied by an editorial comment, and was covered by the news website Cardiology Advisor.