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Application of the Boston Technical Performance Score to intraoperative echocardiography

Echo Research & Practice volume 6, pages 63–70 (2019)Cite this article

Abstract

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.

References

  1. Nathan M, Karamichalis JM, Liu H, del Nido P, Pigula F, Thiagarajan R, Bacha EA. Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: a prospective study. Journal of Thoracic and Cardiovascular Surgery 2011 142 1098–1107, 1107.e1–e5. (https://doi.org/10.1016/j.jtcvs.2011.07.003)

    Article  Google Scholar 

  2. Karamichalis JM, Colan SD, Nathan M, Pigula FA, Baird C, Marx G, Emani SM, Geva T, Fynn-Thompson FE, Liu H, et al. Technical performance scores in congenital cardiac operations: a quality assessment initiative. Annals of Thoracic Surgery 2012 94 1317–1323; discussion 1323. (https://doi.org/10.1016/j.athoracsur.2012.05.014)

    Article  Google Scholar 

  3. Nathan M, Pigula FA, Liu H, Gauvreau K, Colan SD, Fynn-Thompson F, Emani S, Baird CA, Mayer JE, Del Nido PJ. Inadequate technical performance scores are associated with late mortality and late reintervention. Annals of Thoracic Surgery 2013 96 664–669. (https://doi.org/10.1016/j.athoracsur.2013.04.043)

    Article  Google Scholar 

  4. Nathan M, Gauvreau K, Liu H, Pigula FA, Mayer JE, Colan SD, Del Nido PJ. Outcomes differ in patients who undergo immediate intraoperative revision versus patients with delayed postoperative revision of residual lesions in congenital heart operations. Journal of Thoracic and Cardiovascular Surgery 2014 148 2540–2546.e1–5. (https://doi.org/10.1016/j.jtcvs.2014.07.073)

    Article  Google Scholar 

  5. Nathan M, Karamichalis JM, Liu H, Emani S, Baird C, Pigula F, Colan S, Thiagarajan RR, Bacha EA, Del Nido P. Surgical technical performance scores are predictors of late mortality and unplanned reinterventions in infants after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 2012 144 1095.e7–1101.e7. (https://doi.org/10.1016/j.jtcvs.2012.07.081)

    Google Scholar 

  6. Nathan M, Marshall AC, Kerstein J, Liu H, Fynn-Thompson F, Baird CW, Mayer JE, Pigula FA, del Nido PJ, Emani S. Technical performance score as predictor for post-discharge reintervention in valve-sparing tetralogy of Fallot repair. Seminars in Thoracic and Cardiovascular Surgery 2014 26 297–303. (https://doi.org/10.1053/j.semtcvs.2014.12.001)

    Article  Google Scholar 

  7. Nathan M, Sleeper LA, Ohye RG, Frommelt PC, Caldarone CA, Tweddell JS, Lu M, Pearson GD, Gaynor JW, Pizarro C, et al. Technical performance score is associated with outcomes after the Norwood procedure. Journal of Thoracic and Cardiovascular Surgery 2014 148 2208–2213, 2214.e1. (https://doi.org/10.1016/j.jtcvs.2014.05.076)

    Article  Google Scholar 

  8. Nathan M, Gauvreau K, Samnaliev M, Ozonoff A, Jenkins K, Bergesen L, Conor J, Pigula FA, Colan SD, Mayer JE, et al. Technical performance score predicts resource utilization in congenital cardiac procedures. Journal of the American College of Cardiology 2016 67 2696–2698. (https://doi.org/10.1016/j.jacc.2016.03.545)

    Article  Google Scholar 

  9. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. Journal of Thoracic and Cardiovascular Surgery 2002 123 110–118. (https://doi.org/10.1067/mtc.2002.119064)

    Article  Google Scholar 

  10. Stern KWD, Gauvreau K, Emani S, Geva T. Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation. Congenital Heart Disease 2017 12 350–356. (https://doi.org/10.1111/chd.12450)

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank the echocardiography team and theatre team at Evelina London Children’s Hospital.

Funding

The authors (J M S and K P) acknowledge support by the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ National Health Service Foundation Trust in partnership with King’s College London and King’s College Hospital National Health Service Foundation Trust. The Division of Imaging Sciences receives also support as the Centre of Excellence in Medical Engineering (funded by the Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC); grant number WT 088641/Z/09/Z) as well as the British Heart Foundation Centre of Excellence (BHF award RE/08/03).

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Authors and Affiliations

  1. Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, UK

    Hannah R. Bellsham-Revell MD(res), Antigoni Deri MBBS, Silvia Caroli MBBS, Owen I. Miller MD, Sujeev Mathur MBBS, Jelena Saundankar MBBS, David R. Anderson MD, B. Conal Austin MBBS, Caner Salih MD(res), Kuberan Pushparajah MD(res) & John M. Simpson MD(res)

  2. Paediatric Airway Service, Evelina London Children’s Hospital, London, UK

    Andrew Durward FCP

  3. Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK

    Kuberan Pushparajah MD(res) & John M. Simpson MD(res)

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  1. Hannah R. Bellsham-Revell MD(res)
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  2. Antigoni Deri MBBS
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  3. Silvia Caroli MBBS
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  8. David R. Anderson MD
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Correspondence to Hannah R. Bellsham-Revell MD(res).

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Bellsham-Revell, H.R., Deri, A., Caroli, S. et al. Application of the Boston Technical Performance Score to intraoperative echocardiography. Echo Res Pract 6, 63–70 (2019). https://doi.org/10.1530/ERP-19-0032

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Echo Research & Practice

ISSN: 2055-0464

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