Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation

Kenan W D Stern, Kimberlee Gauvreau, Sitaram Emani, Tal Geva

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known. Design: A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative echocardiogram findings with other postoperative investigations was performed. Clinical outcomes, including technical performance, were collected. A historical cohort who received either no echocardiogram or a nonstandardized examination was used as a comparison group. Results: Thirty on-protocol and 30 preprotocol patients, 22 of whom had a nonstandardized intraoperative epicardial echocardiogram, were studied. Compared with preprotocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomosis (93% vs. 68% P=.03) and branch pulmonary arteries (70% vs. 36%, P=.02). One residual lesion requiring immediate operative reintervention was diagnosed in the preprotocol group. There were 5 patients in each cohort with residual lesions during the postoperative hospitalization that were not appreciated on the intraoperative echocardiogram. Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups. Conclusions: Intraoperative epicardial echocardiography is technically feasible and increases visualization of the relevant anatomy. Larger investigations may be warranted to determine if there is clinical benefit to such an approach.

Original languageEnglish (US)
JournalCongenital Heart Disease
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Echocardiography
Anatomy
Operating Rooms
Pulmonary Artery
Thoracic Surgery
Hospitalization

Keywords

  • Epicardial echocardiography
  • Intraoperative echocardiography
  • Protocol
  • Stage I Norwood procedure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation. / Stern, Kenan W D; Gauvreau, Kimberlee; Emani, Sitaram; Geva, Tal.

In: Congenital Heart Disease, 2017.

Research output: Contribution to journalArticle

@article{82b5a0808dbb44fcbe9fbb073770cfe2,
title = "Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation",
abstract = "Objective: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known. Design: A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative echocardiogram findings with other postoperative investigations was performed. Clinical outcomes, including technical performance, were collected. A historical cohort who received either no echocardiogram or a nonstandardized examination was used as a comparison group. Results: Thirty on-protocol and 30 preprotocol patients, 22 of whom had a nonstandardized intraoperative epicardial echocardiogram, were studied. Compared with preprotocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomosis (93{\%} vs. 68{\%} P=.03) and branch pulmonary arteries (70{\%} vs. 36{\%}, P=.02). One residual lesion requiring immediate operative reintervention was diagnosed in the preprotocol group. There were 5 patients in each cohort with residual lesions during the postoperative hospitalization that were not appreciated on the intraoperative echocardiogram. Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups. Conclusions: Intraoperative epicardial echocardiography is technically feasible and increases visualization of the relevant anatomy. Larger investigations may be warranted to determine if there is clinical benefit to such an approach.",
keywords = "Epicardial echocardiography, Intraoperative echocardiography, Protocol, Stage I Norwood procedure",
author = "Stern, {Kenan W D} and Kimberlee Gauvreau and Sitaram Emani and Tal Geva",
year = "2017",
doi = "10.1111/chd.12450",
language = "English (US)",
journal = "Congenital Heart Disease",
issn = "1747-079X",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation

AU - Stern, Kenan W D

AU - Gauvreau, Kimberlee

AU - Emani, Sitaram

AU - Geva, Tal

PY - 2017

Y1 - 2017

N2 - Objective: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known. Design: A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative echocardiogram findings with other postoperative investigations was performed. Clinical outcomes, including technical performance, were collected. A historical cohort who received either no echocardiogram or a nonstandardized examination was used as a comparison group. Results: Thirty on-protocol and 30 preprotocol patients, 22 of whom had a nonstandardized intraoperative epicardial echocardiogram, were studied. Compared with preprotocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomosis (93% vs. 68% P=.03) and branch pulmonary arteries (70% vs. 36%, P=.02). One residual lesion requiring immediate operative reintervention was diagnosed in the preprotocol group. There were 5 patients in each cohort with residual lesions during the postoperative hospitalization that were not appreciated on the intraoperative echocardiogram. Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups. Conclusions: Intraoperative epicardial echocardiography is technically feasible and increases visualization of the relevant anatomy. Larger investigations may be warranted to determine if there is clinical benefit to such an approach.

AB - Objective: Stage 1 Norwood palliation is one of the highest risk procedures in congenital cardiac surgery. Patients with superior technical performance scores have more favorable outcomes. Intraoperative epicardial echocardiography may allow the surgeon to address residual lesions prior to leaving the operating room, resulting in improved technical performance. The ability of intraoperative epicardial echocardiography to visualize the relevant anatomy and its association with outcomes is not known. Design: A standardized intraoperative epicardial echocardiography protocol was developed and performed at the conclusion of Stage 1 Norwood palliation. Data pertaining to visualization of relevant anatomy, and comparison of intraoperative echocardiogram findings with other postoperative investigations was performed. Clinical outcomes, including technical performance, were collected. A historical cohort who received either no echocardiogram or a nonstandardized examination was used as a comparison group. Results: Thirty on-protocol and 30 preprotocol patients, 22 of whom had a nonstandardized intraoperative epicardial echocardiogram, were studied. Compared with preprotocol, visualization of the relevant anatomy was significantly increased for the Damus-Kaye-Stansel anastomosis (93% vs. 68% P=.03) and branch pulmonary arteries (70% vs. 36%, P=.02). One residual lesion requiring immediate operative reintervention was diagnosed in the preprotocol group. There were 5 patients in each cohort with residual lesions during the postoperative hospitalization that were not appreciated on the intraoperative echocardiogram. Technical performance, rates of reintervention and clinical outcomes were not significantly different between the two groups. Conclusions: Intraoperative epicardial echocardiography is technically feasible and increases visualization of the relevant anatomy. Larger investigations may be warranted to determine if there is clinical benefit to such an approach.

KW - Epicardial echocardiography

KW - Intraoperative echocardiography

KW - Protocol

KW - Stage I Norwood procedure

UR - http://www.scopus.com/inward/record.url?scp=85013244014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013244014&partnerID=8YFLogxK

U2 - 10.1111/chd.12450

DO - 10.1111/chd.12450

M3 - Article

JO - Congenital Heart Disease

JF - Congenital Heart Disease

SN - 1747-079X

ER -