RESUMO
Abstract Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Cardiopatias Congênitas , Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias , Boston , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Mortalidade Hospitalar , Países em Desenvolvimento , Tempo de InternaçãoAssuntos
Humanos , Masculino , Adulto , Insuficiência da Valva Tricúspide/cirurgia , Técnica de Fontan/métodos , Procedimento de Blalock-Taussig/métodos , Artéria Pulmonar/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Angiografia/métodos , Ecocardiografia/métodos , Disfunção Ventricular Direita/cirurgia , Dispositivo para Oclusão Septal , Átrios do Coração/cirurgia , Átrios do Coração/diagnóstico por imagemRESUMO
O uso de stents intravasculares em crianças com cardiopatia congênita é procedimento bem estabelecido, porém a indicação de paliação por meio de procedimentos percutâneos ao invés da cirurgia convencional permanece incerta. Neste relato são apresentados três casos de obstrução crítica de via de saída do ventrículo direito (VSVD), submetidos a ampliação da VSVD com implante de stent. O implante foi realizado com sucesso nos três casos, permitindo restabelecer o fluxo pulmonar para a árvore pulmonar e melhorar a saturação de oxigênio.
The use of intravascular stents in children with congenital heart disease is well established, however the use of palliative percutaneous therapy instead of a conventional surgery remains uncertain. We present three cases of critical right ventricular outflow tract (RVOT) obstruction treated with stenting to expand the RVOT. Stenting was successful in all three cases, reestablishing pulmonary flow into the pulmonary arteries and improving oxygen saturation.