Background The Technical Performance Score (TPS) developed by Boston Children’s Hospital showed surgical outcomes correlate with adequacy of technical repair when implemented on pre-discharge echocardiograms. We applied this scoring system to intraoperative imaging in a tertiary UK congenital heart surgical centre. Methods After a period of training, intraoperative TPS (epicardial and/or transesophageal echocardiography) was instituted. TPS was used to inform intraoperative discussions and recorded on a custom-made database using the previously published scoring system. After a year, we reviewed the feasibility, results and relationship between the TPS and mortality, extubation time and length of stay. Results From 01 September 2015 to 04 July 2016, there were 272 TPS procedures in 251 operations with 208 TPS recorded. Seven patients had surgery with no documented TPS, three had operations with no current TPS score template available. Patients left the operating theatre with TPS optimal in 156 (75%), adequate 34 (16%) and inadequate 18 (9%). Of those with an optimal score on leaving theatre, ten had more than one period of cardiopulmonary bypass. All four deaths <30 days after surgery (1.9%) had optimal TPS. There was a statistically significant difference in extubation times in the RACHS category 4 patients (3 days vs 5 days, P < 0.05) and in PICU and total length of stay in the RACHS category three patients (2 and 8 days vs 12.5 and 21.5 days respectively) if leaving theatre with an inadequate result. Conclusions Application of intraoperative TPS is feasible and provides a way of objectively recording intraoperative imaging assessment of surgery. An ‘inadequate’ TPS did not predict mortality but correlated with a longer ventilation time and longer length of stay compared to those with optimal or adequate scores.

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PurposeThe Technical Performance Score (TPS) performed on pre-discharge echocardiograms developed by Boston Children’s Hospital has been shown to correlate with surgical outcomes. We sought to assess the feasibility and applicability of this in intraoperative imaging in a UK congenital cardiac surgical centre.MethodsAfter training, intraoperative TPS (epicardial and/or transoesophageal) was instituted for all cardiac surgical cases. This was used to inform intraoperative discussions using the previously published scoring system. After the first year, we assessed the relationship between the TPS and basic clinical outcomes.ResultsFrom 01/09/15 to 04/07/16 there were 272 TPS procedures in 251 operations. Seven patients had surgery with no documented TPS. Four patients had operations for which there is no current template available. TPS when leaving theatre was: optimal 156 (75%), adequate 34 (16%) and inadequate 18 (9%). Fourteen patients had further runs of cardiopulmonary bypass after an inadequate score, with nine then leaving theatre with an optimal score. There was no significant difference between extubation time for optimal/adequate and inadequate with a median (range) of 1 (0–26 days) and 2.5 (0–11 days) respectively. There were 9 deaths <30 days, none had had an inadequate score.ConclusionsApplication of intraoperative TPS to a tertiary UK congenital heart surgical centre is feasible and provides a meaningful way of objectively recording intraoperative imaging-based assessment of surgical results. There was no significant difference in extubation times (although these can be affected by factors other than surgical result), nor did an ‘inadequate’ TPS score predict mortality.

VC > 0.5cm; PISA > 0.9cm but continuous wave of MR jet not done; Large (> 6cm) holosystolic jet wrapping around left atrium; Peak E wave velocity > 150cm/s.Results MR was observed in 294/1000 patients (29.4%) post-MI, graded as mild (76%), moderate (21%) and severe (3%).Based on MR characteristics alone (not including LVEF), the number of patients fulfilling MITRA-FR and COAPT eligibility criteria were 23 (7.8% of all IMR) and 24 (8.1% of all IMR) respectively. Both groups had a similar ratio of moderate:severe MR (74:26% vs 75:25%), EROA (0.34+/-0.13cm2 vs 0.35+/-0.13cm2), VC (0.6+/-0.2cm vs 0.6+/-0.2cm), RVol (52+/-24ml vs 51+/-25ml), indexed LA volume (LAVi) (54+/-20ml/m2 vs 51+/-20ml/m2), indexed LV end-diastolic volume (LVEDVi) (62+/-17ml/m2 vs 63+/-18ml/m2), LVEF (48+/-13% vs 47+/-13%) and mortality (MITRA-FR: 23% vs COAPT: 29%, p=0.9243).After including LVEF as a criterion, the number of patients eligible for MITRA-FR and COAPT were just 5 (1.7% of all IMR) and 14 (4.7% of all IMR) respectively. As expected, COAPT patients had a higher mean LVEF (MITRA-FR: 33% vs COAPT: 40%; p=0.077). Both groups remained similar with respect to ratio of moderate:severe MR (60:40% vs 64:36%), EROA (0.40+/-0.13 vs 0.38+/-0.15cm2), VC (0.6 +/-0.2cm vs 0.6+/-0.2cm), LAVi (56+/-20ml/m2 vs 50+/-19ml/m2), LVEDVi (69+/-25ml/m2 vs 67+/-19ml/m2) and mortality (MITRA-FR: 40% vs COAPT: 35%). Conclusion. Post-acute MI, more patients with IMR met COAPT criteria (4.7%) than MITRA-FR echocardiographic criteria (1.7%) however both cohorts had similarly high mortality. . Notwithstanding the difference in LVEF, MITRA-FR and COAPT echo criteria identified almost identical cohorts post-MI.