Repair of partial or transitional atrioventricular septal defects (P/TAVSDs) has excellent outcomes; however, late reinterventions remain a concern. Technical performance score (TPS) measures residua ...after repair and has been associated with early/mid-term outcomes after congenital cardiac operation. Our study investigates TPS as a predictor of outcomes after P/TAVSD repair.
This was a single-center retrospective review of P/TAVSD repair from July 2000 to November 2015. Intraoperative and discharge TPS were assigned based on echocardiographic criteria: class 1, no residua; class 2, minor residua; and class 3, major residua or reintervention for major residua. Intensive care unit (ICU) hospital length of stay and reintervention after discharge were analyzed with Cox regression.
In our cohort, 124 partial (68%) and 59 transitional (32%) AVSDs underwent repair. Median age was 1.5 years (interquartile range IQR: 0.6 to 3.8 years), median weight was 9.7 kg (IQR: 6.6 to 14.1 kg), and 96 (52%) were female. Twenty patients (11%) required reintervention after discharge. On multivariable modeling, patients with TPS class 3 spent more days in the ICU (hazard ratio HR 0.33, 95% confidence interval CI: 0.19 to 0.58, p < 0.001) and hospital (HR 0.33, 95% CI: 0.19 to 0.57, p < 0.001) and had shorter time to reintervention after discharge (HR 8.76, 95% CI: 1.03 to 74.7, p = 0.047).
Major residua, that is TPS class 3, were a predictor of in-hospital outcomes and unplanned reinterventions after discharge, with left atrioventricular valve regurgitation being the strongest predictor. Use of TPS as a tool for residual lesions may identify patients predisposed to prolonged ICU hospital stay and reinterventions after discharge, providing feedback on areas in need of improvement in technique and identification of patients who warrant closer follow-up.
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Conclusions: TPS may identify those with prolonged ICU/hospital stay and post-discharge reinterventions, providing feedback on areas of improvement in technique and identification of patients who ...warrant closer follow-up.
Background: Technical Performance Score (TPS), an echocardiographic/clinical based tool that measures residua after congenital cardiac surgery, has been associated with in hospital and midterm ...outcomes.
Background: As part of a blood conservation initiative at our center, we began routine use of cell saver (CS) for all congenital heart surgery (CHS) performed on cardiopulmonary bypass (CPB) in 2014.
Summary
Background
Blood transfusion has well‐documented adverse effects. As part of a blood conservation initiative at our center, we began routine use of cell saver for all congenital heart surgery ...performed on cardiopulmonary bypass since 2014.
Aims
This study aimed to compare transfusion rates prior to, and in the first and second year after this initiative. We hypothesized that cell saver use would decrease transfusion requirements in second year after use of the cell saver compared to the pre cell saver group.
Methods
Consecutive patients under 18 years undergoing congenital heart surgery on cardiopulmonary bypass were retrospectively analyzed as 3 one‐year cohorts defined above. We excluded patients who required mechanical support or reoperation at index admission. Baseline characteristics, and use of blood intraoperatively and postoperatively were compared between groups.
Results
The 3 groups had similar baseline characteristics. Blood use was significantly lower in year 2 after cell saver initiation as compared to the pre cell saver group both intra‐ and postoperatively. The median difference in volume of intraoperative blood transfusion was lower by 138 mL/m2 (−266, −10 mL/m2) in year 2 when compared to the pre cell saver group. Similarly, the proportion of subjects requiring red blood cell transfusion postoperatively on day of surgery was lower by 10% (−15%, −6%).
Conclusion
Standardized use of cell saver significantly decreased perioperative blood use in children undergoing cardiac surgery at our center. A risk‐adjusted transfusion threshold for children undergoing heart surgery needs to be developed to further decrease exposure to blood products and associated costs.
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