Technical Performance Score: Predictor of Outcomes in Complete Atrioventricular Septal Defect Repair

Abstract

At our center, CAVSD repair was associated with low morbidity. TPS may identify patients with complications, prolonged days on ventilator, and who require postdischarge reinterventions; thus, it provides feedback on areas of improvement and allows identification of patients who warrant closer follow-up.

The Pediatric Heart Network Residual Lesion Score Study: Design and objectives

“…Earlier studies suggested the TPS was useful in predicting both short and midterm clinical outcomes, neurodevelopmental outcomes, and costs. [3][4][5][6][7][8][9][10][11][12][13][14][15] However, most studies on TPS were based on a single-center experience. The score name was changed from TPS to RLS in the planning phase of the RLS study because the term TPS may be construed to imply that residual lesions are exclusively the result of the surgeon's technical performance, whereas they may also be a function of the underlying anatomy, the completeness and accuracy of preoperative assessment, and/or intraoperative decision making in which a residual lesion is recognized but deemed to be inconsequential or even therapeutic.…”

Contemporary Outcomes After Repair of Isolated and Complex Complete Atrioventricular Septal Defect

“…Given the complexity of the repair and the anatomy of the AVVs, a second bypass run is not uncommon in CAVSD repair [20,21], yet rarely reported. In this study, the use of a second bypass run to correct residual lesions was effective, with 74% of these patients having the residual defect corrected.…”

Atrioventricular Valve Function Predicts Reintervention in Complete Atrioventricular Septal Defect

“…2 A previous study has shown that the presence of residual lesions before discharge, as measured by TPS, accurately identifies patients requiring postdischarge reinterventions (PD-RI). 3 However, in this previous study, overall TPS was used to determine the association between TPS and PD-RI. The association between individual subcomponents of TPS and PD-RI was not investigated.…”

“…Patients with associated major intracardiac anomalies or partial/transitional AVSD were excluded. Postoperative TPS was determined as previously reported 3 based on predischarge echocardiographic findings and clinical status at discharge from the index operation. The TPS for CAVSD repair included the following subcomponents: size of residual atrial septal defect, size of residual ventricular septal defect (VSD), severity of right and left atrioventricular valve (AVV) stenosis and regurgitations, status of the patent ductus arteriosus, and status of the conduction system.…”

“…Each subcomponent was assigned a score of class 1 (optimal, trivial, or no residua), class 2 (adequate and minor residua), or class 3 (inadequate and major residua), based on specific echocardiographic criteria. 3 The final TPS was based on the subcomponent scores and was class 1 if all subcomponents received a class 1 score, class 2 if one or more of the subcomponents were class 2 but none were class 3, and class 3 if any of the subcomponents were class 3. Any unplanned surgical or catheterbased reintervention for residua in the anatomic area repaired during the CAVSD operation or the need for permanent pacemaker (PPM) placement prior to discharge from index CAVSD surgery resulted in a class 3 (inadequate) score.…”