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Technical performance score is associated with outcomes after the Norwood procedure.

ABSTRACT: The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial.We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned reinterventions that occurred before discharge from the Norwood hospitalization. Multivariable regression examined the association of the TPS with interval to first extubation, Norwood length of stay, death or transplantation, unplanned postdischarge reinterventions, and neurodevelopment at 14 months old.Of 549 patients undergoing a Norwood procedure, 356 (65%) had an echocardiogram adequate to assess atrial septal restriction or arch obstruction or an unplanned reintervention, enabling calculation of the TPS. On multivariable regression, adjusting for preoperative variables, a better TPS was an independent predictor of a shorter interval to first extubation (P=.019), better transplant-free survival before Norwood discharge (P<.001; odds ratio, 9.1 for inadequate vs optimal), shorter hospital length of stay (P<.001), fewer unplanned reinterventions between Norwood discharge and stage II (P=.004), and a higher Bayley II psychomotor development index at 14 months (P=.031). The TPS was not associated with transplant-free survival after Norwood discharge, unplanned reinterventions after stage II, or the Bayley II mental development index at 14 months.TPS is an independent predictor of important outcomes after Norwood and could serve as a tool for quality improvement.

SUBMITTER: Nathan M

PROVIDER: S-EPMC4253672 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Technical performance score is associated with outcomes after the Norwood procedure.

Nathan Meena M Sleeper Lynn A LA Ohye Richard G RG Frommelt Peter C PC Caldarone Christopher A CA Tweddell James S JS Lu Minmin M Pearson Gail D GD Gaynor J William JW Pizarro Christian C Williams Ismee A IA Colan Steven D SD Dunbar-Masterson Carolyn C Gruber Peter J PJ Hill Kevin K Hirsch-Romano Jennifer J Jacobs Jeffrey P JP Kaltman Jonathan R JR Kumar S Ram SR Morales David D Bradley Scott M SM Kanter Kirk K Newburger Jane W JW

The Journal of thoracic and cardiovascular surgery 20140619 5

<h4>Objectives</h4>The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial.<h4>Methods</h4>We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned r ...[more]

PMID: 25037617

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Project description:The transfusion of stored RBCs decreases nitric oxide bioavailability, which may have an adverse effect on vascular function. We assessed the effects of RBC transfusion on coronary vascular function by evaluating the relationship between myocardial oxygen delivery and demand as evidenced by ST segment variability.DesignRetrospective case-control study.SettingNine-hundred seventy-three-bed pediatric hospital with a 54-bed cardiovascular ICU.PatientsSeventy-three neonates with hypoplastic left heart syndrome following the Norwood procedure, 38 with a Blalock-Taussig shunt and 35 with a right ventricle to pulmonary artery shunt.InterventionsRBC transfusion.Materials and main resultsHigh-frequency physiologic data were captured 30 minutes prior to the initiation of (baseline) and during the 120 minutes of the transfusion. A rate pressure product was calculated for each subject and used as an indicator of myocardial oxygen demand. Electrocardiogram leads (aVL, V1, II) were used to construct a 3D ST segment vector to assess ST segment variability and functioned as a surrogate indicator of myocardial ischemia. One-hundred thirty-eight transfusions occurred in the Blalock-Taussig shunt group and 139 in the right ventricle to pulmonary artery shunt group. There was no significant change in the rate pressure product for either group; however, ST segment variability progressively increased for the entire cohort during the transfusion, becoming statistically significant by the end of the transfusion. Upon subgroup analysis, this finding was noted with statistical significance in the Blalock-Taussig shunt group and trending toward significance in the right ventricle to pulmonary artery shunt group.ConclusionsWe found a significant increase in the ST segment variability and evidence of myocardial ischemia temporally associated with RBC transfusions in neonates following the Norwood procedure, specifically among those in the Blalock-Taussig shunt group, which may impact immediate and long-term outcomes.

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Technical performance score is associated with outcomes after the Norwood procedure.

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Technical performance score is associated with outcomes after the Norwood procedure.

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