Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-28T17:04:44.084Z Has data issue: false hasContentIssue false
  • English
  • Français

Development of the Residual Lesion Score for congenital heart surgery: the RAND Delphi methodology

Published online by Cambridge University Press:  23 December 2022

Meena Nathan Open the ORCID record for Meena Nathan [Opens in a new window] ,
Jane W. Newburger ,
Margaret Bell ,
Alexander Tang ,
Russell Gongwer ,
Carolyn Dunbar-Masterson ,
Andrew M. Atz ,
Emile Bacha ,
Steven Colan  and
J. William Gaynor
...Show all authors
Meena Nathan*
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA Department of Surgery, Harvard Medical School, Boston, MA, USA
Jane W. Newburger
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Margaret Bell
Affiliation:
Department of Cardiac Psychiatry Research Program, Massachusetts General Hospital, Boston, MA, USA
Alexander Tang
Affiliation:
Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
Russell Gongwer
Affiliation:
HealthCore, Watertown, MA, USA
Carolyn Dunbar-Masterson
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
Andrew M. Atz
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
Emile Bacha
Affiliation:
Division of Cardiothoracic Surgery, New York-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
Steven Colan
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
J. William Gaynor
Affiliation:
Division of Cardiac Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Kirk Kanter
Affiliation:
Division of Pediatric Cardiac Surgery, Emory University School of Medicine, Atlanta, GA, USA
Jami C. Levine
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Richard Ohye
Affiliation:
Division of Pediatric Cardiac Surgery, C. S. Mott Children’s Hospital, Ann Arbor, MI, USA
Christian Pizarro
Affiliation:
Division of Cardiac Surgery, Nemours Cardiac Center, Alfred I duPont Hospital for Children, Wilmington, DE, USA
Steven Schwartz
Affiliation:
Division of Cardiac Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
Girish Shirali
Affiliation:
Heart Center, Children’s Mercy Hospital, Kansas City, MO, USA
Lloyd Tani
Affiliation:
Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
James Tweddell
Affiliation:
Division of Pediatric Cardiac Thoracic Surgery, Cincinnati Children’s Hospital and Medical Center (Posthumous), Cincinnati, OH, USA
Michelle Gurvitz
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Meena Nathan MD, MPH, Department of Cardiac Surgery, Bader 273, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Tel: +1 617 355 7932; Fax: +1 617 730 0214. E-mail: meena.nathan@cardio.chboston.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and Objective:

The Residual Lesion Score is a novel tool for assessing the achievement of surgical objectives in congenital heart surgery based on widely available clinical and echocardiographic characteristics. This article describes the methodology used to develop the Residual Lesion Score from the previously developed Technical Performance Score for five common congenital cardiac procedures using the RAND Delphi methodology.

Methods:

A panel of 11 experts from the field of paediatric and congenital cardiology and cardiac surgery, 2 co-chairs, and a consultant were assembled to review and comment on validity and feasibility of measuring the sub-components of intraoperative and discharge Residual Lesion Score for five congenital cardiac procedures. In the first email round, the panel reviewed and commented on the Residual Lesion Score and provided validity and feasibility scores for sub-components of each of the five procedures. In the second in-person round, email comments and scores were reviewed and the Residual Lesion Score revised. The modified Residual Lesion Score was scored independently by each panellist for validity and feasibility and used to develop the “final” Residual Lesion Score.

Results:

The Residual Lesion Score sub-components with a median validity score of ≥7 and median feasibility score of ≥4 that were scored without disagreement and with low absolute deviation from the median were included in the “final” Residual Lesion Score.

Conclusion:

Using the RAND Delphi methodology, we were able to develop Residual Lesion Score modules for five important congenital cardiac procedures for the Pediatric Heart Network’s Residual Lesion Score study.

Keywords

Congenital Heart DiseaseResidual Lesion ScoreconsensusRAND Delphi methodology
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 6 , June 2023 , pp. 977 - 990
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Nathan, M, Trachtenberg, FL, Van Rompay, MI, et al. The pediatric heart network residual lesion score study: design and objectives. J Thorac Cardiovasc Surg 2020; 160: 218–223.CrossRefGoogle ScholarPubMed
Larrazabal, A, Del Nido, PJ, Jenkins, K, et al. Measurement of technical performance in congenital heart surgery: a pilot study. Ann Thorac Surg 2007; 83: 179–184.CrossRefGoogle ScholarPubMed
Bacha, EA, Larrazabal, LA, Pigula, FA, et al. Measurement of technical performance in surgery for congenital heart disease: the stage I Norwood procedure. J Thorac Cardiovasc Surg 2008; 136: 993–997.CrossRefGoogle Scholar
Nathan, M, Karamichalis, J. Quality Improvement: Surgical Performance. Technical Performance Score as a performance measure for congenital heart surgery. In Sellke/Sabiston and Spencer’s Surgery of the Chest, 9th edn., 2015, Chapter 134,Google Scholar
Brook, RH. The RAND/UCLA appropriateness methodology. In: McCormack, KA, Moore, SR, Seigal, RA (eds). Clinical Practice Guidelines Development: Methodology Perspectives. Agency for Health Care Policy and Research, Rockville, MD, 1994.Google Scholar
McGlynn, EA, Kosecoff, J, Brook, RH. Format and conduct of consensus development conferences: a multi-nation comparison. In: Goodman, C, Baratz, S (eds). Improving Consensus Development for Health Technology Assessment. National Academy Press, Washington, D.C, 1990.Google Scholar
Nathan, M, Sadhwani, A, Gauvreau, K, et al. Association between Technical Performance Scores and neurodevelopmental outcomes after congenital cardiac surgery. J Thorac Cardiovasc Surg 2014; 147: 389–394.CrossRefGoogle Scholar
Nathan, M, Sleeper, L, Ohye, R, et al. Pediatric Heart Network Investigators. Technical Performance Score is associated with outcomes after the Norwood procedure. J Thorac Cardiovasc Surg 2014; 148: 2208–2213.CrossRefGoogle ScholarPubMed
Nathan, M, Liu, H, Gauvreau, K, et al. Outcomes differ in patients who undergo immediate intraoperative revision vs. patients with delayed postoperative revisions of residual lesions in congenital heart operations. J Thorac Cardiovasc Surg 2014; 148: 2450–2456.CrossRefGoogle Scholar
Nathan, M, Gauvreau, K, Samnaliev, M, et al. Technical Performance Score predicts resource utilization in congenital cardiac procedures. J Am Coll Cardiol 2016; 67: 2696–2698.CrossRefGoogle ScholarPubMed
Howard, TS, Kalish, BT, Wigmore, D, et al. Association of ECMO support adequacy and residual lesions on outcomes in neonates supported after cardiac surgery. Ped Crit Care Med 2016; 17: 1045–1054.CrossRefGoogle ScholarPubMed
Martin, E, Del Nido, PJ, Nathan, M. Technical performance scores are predictors of midterm mortality and reinterventions following congenital mitral valve repair. Eur J Cardiothorac Surg. 2017; 52: 218–224.CrossRefGoogle ScholarPubMed
IJsselhof, R, Gauvreau, K, del Nido, P, Nathan, M. Technical Performance Score is a predictor for post-discharge reinterventions following complete atrioventricular septal defect repair. Ann Thorac Surg. 2017; 104: 1371–1377.CrossRefGoogle Scholar
Tishler, B, Gauvreau, K, Colan, SD, Del Nido, P, Nathan, M. Technical Performance Score predicts partial/transitional atrioventricular septal defect outcomes. Ann Thorac Surg. 2018; 105: 1461–1468.CrossRefGoogle ScholarPubMed
Muter, A, Evans, HM, Gauvreau, K, et al. Technical Performance Score’s association with arterial switch operation outcomes. Ann Thorac Surg 2020; 111: 1367–1373.CrossRefGoogle ScholarPubMed
Michalowski, AK, Gauvreau, K, Kaza, A, et al. Technical Performance Score: a predictor of outcomes after the Norwood procedure. Ann Thorac Surg 2021; 112: 1290–1297.CrossRefGoogle Scholar
Miana, LA, Nathan, M, Tenorio, DF, et al. Translation and validation of the Boston Technical Performance Score in a developing country. Braz J Cardiovasc Surg 2021; 36: 589–598.CrossRefGoogle ScholarPubMed
Sengupta, A, Gauvreau, K, Kohlsaat, K, et al. Comparison of intraoperative and discharge residual lesion severity in congenital heart surgery. Ann Thorac Surg 2022; 114: 1731–1738.CrossRefGoogle ScholarPubMed
Sengupta, A, Gauvreau, K, Kohlsaat, K, et al. Intraoperative technical performance score predicts outcomes following congenital cardiac surgery. Ann Thorac Surg 2022, [Epub ahead of print].Google Scholar
Sengupta, A, Gauvreau, K, Kohlsaat, K, et al. Long-term outcomes of patients requiring unplanned repeated interventions after surgery for congenital heart disease. J Am Coll Cardiol 2022; 70: 2489–2499.CrossRefGoogle Scholar
Sengupta, A, Gauvreau, K, Kohlsaat, K, et al. Intraoperative residual lesion score predicts predischarge major residual lesions and reinterventions following congenital heart surgery. J Am Coll Cardiol 2022; 80: 1202–1204.CrossRefGoogle ScholarPubMed
Sengupta, A, Gauvreau, K, Kaza, A, et al. Influence of intraoperative residual lesions and timing of extracorporeal membrane oxygenation on outcomes following first-stage palliation of single-ventricle heart disease. J Thorac Cardiovasc Surg 2022, [Epub ahead of print].Google ScholarPubMed
Sengupta, A, Gauvreau, K, Marx, GR, et al. Residual lesion severity predicts mid-term outcomes following congenital aortic valve repair. Ann Thorac Surg 2022, [Epub ahead of print].Google Scholar
Sengupta, A, Gauvreau, K, Kaza, A, Hoganson, D, Del Nido, PJ, Nathan, M. Timing of reintervention influences survival and resource utilization following first-stage palliation of single ventricle heart disease. J Thorac Cardiovasc Surg 2022, [Epub ahead of print].Google ScholarPubMed
Gurvitz, M, Marelli, A, Mangione-Smith, R, Jenkins, K. Building quality indicators to improve care for adults with congenital heart disease. J Am Coll Cardiol 2013; 62: 2244–2253.CrossRefGoogle ScholarPubMed
Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
O'Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009; 138: 1139–1153.CrossRefGoogle ScholarPubMed
Jacobs, ML, Jacobs, JP, Thibault, D, et al. Updating an empirically based tool for analyzing congenital heart surgery mortality. World J Pediatr Congenit Heart Surg. 2021; 12: 246–281.CrossRefGoogle ScholarPubMed