title: Technical performance score as predictor for post-discharge reintervention in valve-sparing tetralogy of Fallot repair.
abstract: Recognition of late problems following repair of tetralogy of Fallot (TOF) with a transannular patch has stimulated modifications to preserve pulmonary valve (PV) function. This study assesses the ability of technical performance score (TPS) to determine the need for post-discharge reinterventions (RIs) in valve-sparing TOF repair. We retrospectively reviewed 157 patients following valve-sparing repair of TOF from 2007-2012. We assigned TPS as Class 1 (optimal), Class 2 (adequate), or Class 3 (inadequate) based on discharge echo and clinical criteria. Preoperative, discharge, and follow-up PV Z scores and post-discharge RIs were documented. Reasons for Class 2 or 3 designation were right ventricular outflow tract (RVOT) gradient in 52, pulmonary regurgitation in 13, residual ventricular septal defects in 7, both RVOT gradient and ventricular septal defects in 13, and both RVOT gradient and pulmonary regurgitation in 37 patients. Median follow-up was 19.6 (range: 0.1-86.1) months. Class 3 patients had a significantly longer median intensive care unit and hospital stay compared with Class 1 (3 vs 2 days [P = 0.015] and 7 vs 5 days [P < 0.001], respectively). Post-discharge RIs were significantly lower in Class 1 vs Class 2 and Class 3 (P = 0.003). Class 1 patients had significantly larger PV Z scores compared with Class 2 or Class 3 patients (P < 0.001). TPS is associated with post-discharge RI rate after valve-sparing TOF repair. Preoperative PV Z score is highly correlated with Class I TPS. Patient selection based on preoperative PV Z scores may help determine if valve-sparing approach is appropriate, thus minimizing the need for RIs.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: meena.nathan@cardio.chboston.org.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jason
authors.initials: J
authors.lastname: Kerstein
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Emani
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000601:surgery*; D011237:Predictive Value of Tests; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013647:Task Performance and Analysis; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: congenital cardiac surgery; outcomes; pulmonary stenosis; technical performance score; tetralogy of Fallot; valve sparing repair