Introduction
Single-ventricle patients with elevated pulmonary vascular resistance (PVR) or end-diastolic pressure (EDP) are excluded from undergoing total cavopulmonary connection (TCPC). However, a subset of patients deemed acceptable risk experience prolonged length of stay (LOS) after TCPC. Routine assessment of ventricular function has been inadequate in identifying these high risk patients. Speckle-tracking echocardiography (STE) is a novel method for assessment of myocardial deformation that may be useful in single-ventricle patients. The aim of this study was to perform a contemporary pre-operative risk assessment for prolonged LOS to determine if STE improves risk stratification prior to TCPC.
Methods
Our single institution's perioperative data was retrospectively collected. The primary outcome was post-operative LOS > 14 days. Longitudinal and circumferential STE deformation measures were analyzed on echocardiograms obtained during pre-operative catheterization. Patient-specific, echocardiographic, and catheterization data were included in multi-variable logistic regression. Receiver operating characteristic area under the curves (AUC) were analyzed.
Results
From 2007-2014, 135 who underwent TCPC could be included in the analysis. Median LOS was 11 (IQR 9-14) days. PVR (p<0.01) and circumferential strain rate (CSR) (p<0.01) were the only variables independently associated with LOS > 14 days. For every 0.1 s−1 CSR increased, there was a 20% increased odds of prolonged LOS. The AUC for CSR was 0.70. The AUC for PVR and EDP combined was 0.68. The AUC for PVR, EDP, and CSR combined was 0.73.
Conclusion
Pre-operative CSR is independently associated with LOS > 14 days and improves pre-operative risk stratification in patients undergoing TCPC.