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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

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Technical Performance Score Predicts Partial/Transitional Atrioventricular Septal Defect Outcomes.

Brielle Tishler¹, Kimberlee Gauvreau², Steven D Colan²

¹Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.

The Annals of Thoracic Surgery

|December 23, 2017

Summary

This summary is machine-generated.

Technical performance score (TPS) class 3 after atrioventricular septal defect repair predicts longer hospital stays and reinterventions. This score helps identify patients needing closer follow-up and areas for surgical technique improvement.

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Area of Science:

Pediatric Cardiology
Congenital Heart Surgery
Echocardiography

Background:

Repair of partial or transitional atrioventricular septal defects (P/TAVSDs) yields excellent outcomes, but late reinterventions are a concern.
Technical Performance Score (TPS) assesses residual defects post-repair and correlates with early/mid-term outcomes.
This study evaluates TPS as a predictor of outcomes following P/TAVSD repair.

Purpose of the Study:

To investigate the Technical Performance Score (TPS) as a predictor of outcomes after P/TAVSD repair.
To determine if TPS can identify patients at higher risk for prolonged hospitalization and reintervention.
To provide feedback for improving surgical techniques in P/TAVSD repair.

Main Methods:

Retrospective review of 183 P/TAVSD repairs (July 2000-November 2015) at a single center.
Intraoperative and discharge TPS assigned based on echocardiographic criteria (Class 1: no residua, Class 2: minor residua, Class 3: major residua/reintervention).
Analysis of ICU length of stay and post-discharge reintervention rates using Cox regression.

Main Results:

11% of patients required reintervention after discharge.
Multivariable analysis showed TPS Class 3 was associated with longer ICU and hospital stays.
TPS Class 3 significantly increased the risk of reintervention after discharge (HR 8.76, p=0.047).

Conclusions:

Major residual defects (TPS Class 3) predict adverse in-hospital outcomes and unplanned reinterventions.
Left atrioventricular valve regurgitation was the strongest predictor of poor outcomes.
TPS is a valuable tool for identifying patients at risk for prolonged ICU stays and reinterventions, guiding follow-up and surgical technique refinement.