Revisiting the utility of technical performance scores following tetralogy of Fallot repair

Lodin, Daud; Mavrothalassitis, Orestes; Haberer, Kim; Sunderji, Sherzana; Quek, Ruben G.W.; Peyvandi, Shabnam; Moon-Grady, Anita J.; Karamlou, Tara

doi:10.1016/j.jtcvs.2017.02.066

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…PHS is one of the most important outcome measures for congenital cardiovascular surgery ( 17 , 23 ). Herein, we reported a mean PHS of 12 (4–97) days, which is longer than the seven (interquartile range 4–12) days and eight (interquartile range, 6–10) days reported by Mercer-Rosa et al ( 17 ) and Lodin et al ( 21 ), respectively. The main reason is that they defined discharge as release either to home or to a chronic care facility.…”

Section: Discussioncontrasting

confidence: 58%

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Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

et al. 2021

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Objectives: To evaluate the predictive value of the pulmonary vein index (PVI) in the early prognosis of patients who received total tetralogy of Fallot (TOF) repair.Methods: We retrospectively reviewed 286 patients who underwent TOF repair in our institution between July 2013 and May 2020. The PVI, McGoon ratio, and Nakata index were measured and calculated. Logistic regression, linear stepwise regression, receiver operating characteristic (ROC) curve analysis, and Cox proportional hazards modeling were performed to evaluate the predictive value of PVI in the early prognosis after TOF repair surgery.Results: The median age and body weight were 1.23 (0.22–15.02) years and 9.00 (3.00–44.00) kg, respectively. There were five early deaths. The areas under the ROC curve for death were 0.89, 0.79, and 0.88 for the McGoon ratio, Nakata index, and PVI, respectively. A lower PVI better predicted prolonged postoperative hospital stay, cardiac intensive care unit stay, and ventilator time (Hazard Ratio, HR [95% Confidence intervals, CI]: 1.003 [1.002–1.004], p < 0.001; 1.002 [1.001–1.004], p < 0.001; 1.002 [1.001–1.003], p < 0.001, respectively) and was a significant risk factor for high 24 h max Vasoactive inotropic score (Crude Odds Ratio [OR] [95% CI]: −0.015 [−0.022, −0.007], p < 0.001), serous effusion (Crude OR [95% CI]: 0.996 [0.992–0.999], p = 0.020), delayed sternal closure (Crude OR [95% CI]: 0.983 [0.971–0.996], p = 0.010), and the need for peritoneal dialysis (Crude OR [95% CI]: 0.988 [0.980–0.996], p = 0.005). The area under the ROC curve of PVI for delayed postoperative recovery was 0.722 (p < 0.001), and the estimated cutoff point was 300.3 mm2/m2.Conclusion: PVI is a good predictor of early prognosis for surgical treatment of TOF patients.

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Section: Discussioncontrasting

confidence: 58%

“…In TOF, the postoperative hospital course can vary in terms of length of mechanical ventilation, postoperative complications, and PHS ( 21 , 22 ). PHS is one of the most important outcome measures for congenital cardiovascular surgery ( 17 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

et al. 2021

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“…Not only is LOHS a metric of early surgical outcome, it is also associated with long‐term neurodevelopmental outcomes in children with congenital heart defects . In TOF, the postoperative hospital course can vary by length of mechanical ventilation, postoperative complications, and LOHS . Some cited risk factors for prolonged hospital stay include aortic cross‐clamp time, delayed sternal closure, length of intubation, extubation failure, and worse technical performance scores .…”

Section: Introductionmentioning

confidence: 99%

“…In TOF, the postoperative hospital course can vary by length of mechanical ventilation, postoperative complications, and LOHS . Some cited risk factors for prolonged hospital stay include aortic cross‐clamp time, delayed sternal closure, length of intubation, extubation failure, and worse technical performance scores . However, most studies examining predictors of LOHS are retrospective without detailed research‐grade data collection, use clinical databases without granular data points, and focus on a particular feature of TOF, such as timing of repair, genotype, or subtypes of TOF (for example, pulmonary atresia and association with atrioventricular canal defects) .…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Some cited risk factors for prolonged hospital stay include aortic cross-clamp time, delayed sternal closure, length of intubation, extubation failure, and worse technical performance scores. 7,8 However, most studies examining predictors of LOHS are retrospective without detailed research-grade data collection, use clinical databases without granular data points, and focus on a particular feature of TOF, such as timing of repair, genotype, or subtypes of TOF (for example, pulmonary atresia and association with atrioventricular canal defects). 9,10 We sought to identify patient and surgical factors associated with postoperative LOHS with prospective ascertainment of data.…”

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Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Mercer‐Rosa

Elci

DeCost

et al. 2018

JAHA

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BackgroundWe sought to identify patient and surgical factors associated with time to hospital discharge in patients undergoing complete repair for tetralogy of Fallot.Methods and ResultsWe performed a prospective cohort study of patients with tetralogy of Fallot admitted for complete repair between May 1, 2012 and June 2, 2017 at Children's Hospital of Philadelphia with detailed demographic, clinical, and operative characteristics. The primary outcome was time to hospital discharge. Cox proportional hazards models were used to identify patient and operative predictors of time to hospital discharge. We enrolled 151 subjects, 62.8% male, 65.6% non‐Hispanic white, and 9.9% non‐Hispanic black. The median time to hospital discharge was 7 days (interquartile range 4, 12). Five patients died in the hospital, all of whom underwent tetralogy of Fallot repair beyond the neonatal period. Greater birth weight was associated with higher rate of hospital discharge (hazard ratio [HR]=1.35, 95% confidence interval (CI) =1.11, 1.64), while absent pulmonary valve versus pulmonary stenosis (HR=0.27, 95% CI=0.08, 0.91), pulmonary valve atresia versus pulmonary stenosis (HR=0.57, 95% CI=0.33, 0.97), presence of aortopulmonary collaterals (HR=0.44, 95% CI=0.24, 0.84), complete repair performed in the neonatal period (<30 days of life) (HR=0.45, 95% CI=0.27, 0.75), more than 1 cardiopulmonary bypass run (HR=0.33, 95% CI=0.18, 0.61), and longer aortic cross‐clamp time (HR [per 10 minutes]=0.88, 95% CI=0.79, 0.97) were associated with lower rate of hospital discharge.ConclusionsPostoperative hospital stay after complete repair of tetralogy of Fallot is in part determined by patient and operative factors. Some (eg, surgical strategy for the symptomatic neonate) may be modifiable. These results may impact patient counseling, choice of surgical approach, and postoperative care.

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Technical Performance in Norwood Procedures: Bad Is Still Bad

Karamlou

Najm

2021

The Annals of Thoracic Surgery

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Revisiting the utility of technical performance scores following tetralogy of Fallot repair

Cited by 8 publications

References 24 publications

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Technical Performance in Norwood Procedures: Bad Is Still Bad

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