title: Technical performance scores are predictors of midterm mortality and reinterventions following congenital mitral valve repair.
abstract: OBJECTIVE
  The Technical Performance Score (TPS) has been shown to be predictive of postoperative mortality, morbidities and reinterventions following various cardiac procedures in children. We hypothesized that TPS is also a predictor of mitral valve repair outcomes.
  
  
  METHODS
  A review of patients who underwent mitral valve repair from January 2000 to December 2013 was performed. Primary repair of complete atrioventricular defect was excluded. The scores were determined according to previously published criteria based on the need for reintervention and predischarge echocardiograms: Class 1 (no residua), Class 2 (minor residua) or Class 3 (pacemaker implantation, major residua or reintervention for major residua prior to discharge). Cox proportional hazard models and Kaplan-Meier estimator were used.
  
  
  RESULTS
  A total of 587 patients underwent mitral repair (median age 2.6 years). Median follow-up duration was 3 years. There were 125 (21.3%) post-discharge mitral reinterventions and freedom from reintervention was 85.2%, 78.2% and 69.4% at 1, 2 and 5 years, respectively. Both TPS Class 2 [hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.4-10.0; P  = 0.02] and Class 3 (HR 8.7, 95% CI 3.0-25.1; P  < 0.001) were associated with post-discharge reinterventions. There were 31 late deaths/transplantations, and transplant-free survival at 1, 2 and 5 years was 97.8%, 95.3% and 93.2%. TPS 3 was associated with decreased post-discharge transplant-free survival (HR 5.5, 95% CI 1.2-25.0; P  = 0.03). Post-discharge mitral reintervention was not associated with increased mortality.
  
  
  CONCLUSIONS
  The TPS is a strong predictor of midterm mortality and post-discharge mitral reintervention in congenital patients who underwent mitral repair.
authors.affiliation: Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada.|Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Martin
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D006349:Heart Valve Diseases / Q000151:congenital / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Congenital; Mitral valve repair ; Mortality ; Reintervention 