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Ann Thorac Surg 2007;83:179-184
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Measurement of Technical Performance in Congenital Heart Surgery: A Pilot Study

^a Department of Cardiac Surgery, Children’s Hospital Boston, Harvard Medical School, Boston Massachusetts
^b Department of Cardiology, Children’s Hospital Boston, Harvard Medical School, Boston Massachusetts

Accepted for publication July 18, 2006.

^_* Address correspondence to Dr Bacha, Cardiac Surgery, Children’s Hospital Boston 300 Longwood Ave, Boston, MA 02115 (Email: emile.bacha{at}cardio.chboston.org).

BACKGROUND: Although adequacy of repair after congenital heart surgery is a crucial determinant of clinical outcome, there is no current method of assessment. We sought to develop a process to measure the adequacy of repair for a diverse group of congenital heart procedures.

METHODS: Selected surgical procedures, consisting of repair of ventricular septal defect (VSD), tetralogy of Fallot (TOF), complete common atrioventricular canal (CAVC), and arterial switch operation, were divided into component subprocedures, each of which was assessed separately. Three outcome categories of "optimal," "adequate," and "inadequate" were defined by consensus according to postprocedure echocardiographic assessment. Outcome categories for conduction disturbance were also created. All patients undergoing one of the four procedures in 2004 were identified, and each subprocedure was assessed. Other clinical data were obtained from medical records. Repairs were scored as "optimal" if all attempted subprocedures and conduction were optimal, and "inadequate" if any was inadequate.

RESULTS: A total of 138 procedures were included. VSD repair was done in 46 patients (33%), TOF repair in 33 (24%), arterial switch operation in 36 (26%), and CAVC repair in 23 (17%). Optimal technical score was found in 28 (20%), adequate in 106 (77%), and inadequate in 4 (3%) (2 VSD, 1 TOF, 1 CAVC). Median length of stay was 8 days, and no patients died.

CONCLUSIONS: Despite procedural diversity and complexity, technical adequacy of repair can be assessed for congenital heart surgery.

This article has been cited by other articles:

				E. A. Bacha, L. A. Larrazabal, F. A. Pigula, K. Gauvreau, K. J. Jenkins, S. D. Colan, F. Fynn-Thompson, J. E. Mayer Jr., and P. J. del Nido Measurement of technical performance in surgery for congenital heart disease: The stage I Norwood procedure J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 993 - 997. [Abstract] [Full Text] [PDF]