title: Influence of Age and Weight on Technical Repair of Tetralogy of Fallot.
abstract: BACKGROUND
  We have previously shown that early primary repair of tetralogy of Fallot can be performed without increased morbidity or resource utilization. The technical performance score (TPS) is a self-assessment tool used to identify patients at risk of poor postoperative outcomes. We hypothesized that adequate technical repair can be obtained regardless of the patient's preoperative age or size.
  
  
  METHODS
  A retrospective review of all tetralogy of Fallot patients repaired between September 2004 and December 2013 was performed. The postoperative predischarge echocardiogram was reviewed to assign a TPS rating of optimal, adequate, or inadequate. The TPS groups were compared by univariate analysis using the Kruskal-Wallis test for continuous variables and χ(2) analysis for categoric variables. Multivariable logistic regression analysis was performed to identify independent predictors of inadequate TPS.
  
  
  RESULTS
  Among 167 patients (1 operative mortality), TPS was optimal in 88, adequate in 62, and inadequate in 17. Patients with worse TPS had longer ventilation time (p = 0.031), hospital length of stay (p = 0.036), and higher hospital charges (p = 0.005). Multivariable regression analysis revealed discontinuous branch pulmonary arteries (odds ratio 18.24, 95% confidence interval: 1.42 to 234, p = 0.015) as the only independent predictor of inadequate TPS. Younger age at repair (p = 0.245) and smaller weight (p = 0.260) were not associated with inadequate TPS.
  
  
  CONCLUSIONS
  Technical adequacy of tetralogy of Fallot repair is affected by anatomic subsets (discontinuous branch pulmonary arteries) and not by the patient's age or size. Worse TPS is associated with higher postoperative morbidity and hospital charges. Younger age and size should not be a deterrent for early primary repair.
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, DC.
authors.forename: Michael E A
authors.initials: MEA
authors.lastname: Cunningham
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, DC.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Donofrio
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, DC.
authors.forename: Syed Murfad
authors.initials: SM
authors.lastname: Peer
authors.affiliation: Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, DC.
authors.forename: Richard
authors.initials: R
authors.lastname: Jonas
authors.affiliation: Department of Cardiovascular Surgery, Children's National Health System, Washington, DC. Electronic address: psinha@childrensnational.org.
authors.forename: Pranava
authors.initials: P
authors.lastname: Sinha
mesh_terms: D000367:Age Factors; D001835:Body Weight; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*