Related Experiment Video
Updated: Sep 27, 2025
Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
Comparison of Intraoperative and Discharge Residual Lesion Severity in Congenital Heart Surgery
Aditya Sengupta1, Kimberlee Gauvreau2, Katherine Kohlsaat1
1Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Insights
Intraoperative technical performance scores (IO-TPS) and predischarge scores (DC-TPS) are valuable for assessing congenital cardiac surgery outcomes. Both scores predict mortality and reintervention risk, aiding quality improvement efforts.
Area of Science:
- Cardiology
- Pediatric Surgery
- Medical Technology Assessment
Background:
- The predischarge technical performance score (DC-TPS) is linked to outcomes in congenital cardiac surgery.
- The predictive value of the intraoperative TPS (IO-TPS) for these outcomes is not well understood.
Purpose of the Study:
- To evaluate the utility of the intraoperative technical performance score (IO-TPS) in congenital cardiac surgery.
- To compare the predictive performance of IO-TPS and DC-TPS for postoperative outcomes.
Main Methods:
- Retrospective review of 6201 patients undergoing congenital cardiac surgery (2011-2019).
- Assignment of IO-TPS and DC-TPS based on intraoperative and predischarge echocardiograms.
- Multivariable regression models used to compare IO-TPS and DC-TPS in predicting mortality and reintervention.
Main Results:
- Overall agreement between IO-TPS and DC-TPS was 68.6%, with scores often worse at discharge.
- Class 3 patients (major residual lesions) showed increased risk for in-hospital/early and postdischarge/late mortality with both scores.
- Both IO-TPS and DC-TPS models demonstrated equivalent predictive power for early and late mortality.
Conclusions:
- Both intraoperative (IO-TPS) and predischarge (DC-TPS) technical performance scores are significant adjuncts for quality improvement in congenital cardiac surgery.
- These scores aid in predicting patient outcomes and identifying areas for procedural enhancement.
Background:
While the predischarge technical performance score (DC-TPS) is significantly associated with outcomes after congenital cardiac surgery, the utility of the intraoperative TPS (IO-TPS) remains unknown.
Methods:
This was a single-center retrospective review of consecutive patients who underwent congenital cardiac surgery from January 2011 to December 2019. Intraoperative and predischarge echocardiograms were used to assign IO-TPS and DC-TPS, respectively, for each index operation (class 1, no residua; class 2, minor residua; class 3, major residua). Anatomic modules identifying the principal residual lesion were assigned to all class 2/3 patients. Overall and module-specific TPS comparisons were made. Multivariable regression models with IO-TPS and DC-TPS as separate predictors of postoperative outcomes were compared.
Results:
Of 6201 patients, overall agreement between IO-TPS and DC-TPS was observed in 4251 patients (68.6%); scores were likelier to be worse at discharge (P < .001). Paired comparative analyses revealed that among patients with at least class 2 atrioventricular and semilunar valve residua, IO-TPS was likelier to worsen than improve (both P < .001). Class 3 patients had a higher risk of in-hospital/early mortality (IO-TPS: odds ratio, 7.5; 95% CI, 2.4-23; DC-TPS: odds ratio, 6.6; 95% CI, 3.0-15), postdischarge/late mortality (IO-TPS: hazard ratio [HR], 3.1, 95% CI, 1.3-7.1; DC-TPS: HR, 2.3; 95% CI, 1.2-4.4), and late unplanned reintervention (IO-TPS: HR, 2.8; 95% CI, 1.9-4.0; DC-TPS: HR, 3.4; 95% CI, 2.8-4.2) vs class 1 (all P < .05). IO- and DC-TPS models were equivalent fits for predicting early and late mortality; the latter was a marginally better fit for late reintervention.
Conclusions:
IO-TPS and DC-TPS are both important adjuncts for quality improvement in congenital cardiac surgery.
