Author + information
- Claudia A. Algaze,
- Lynn F. Peng,
- Jeffrey A. Feinstein,
- V. Mohan Reddy,
- Frank L. Hanley and
- Stanton B. Perry
The anatomic variability in tetralogy of Fallot with pulmonary atresia (PA) or pulmonary stenosis (PS) and major aortopulmonary collateral arteries (MAPCA) makes it difficult to compare outcomes for different therapeutic approaches. We developed a novel anatomy-based classification system and risk score for MAPCA's.
A retrospective review identified 128 patients with tetralogy of Fallot/PS or PA/MAPCA with pre-operative angiograms adequate to identify number; origin: transverse aorta, descending aorta (DTA), abdominal aorta, subclavian artery, and coronary artery; type: dual supply, single supply (SS), mixed supply and patent ductus arteriosus; distribution: number and name of bronchopulmonary segments supplied; and stenoses.
We identified 475 MAPCA and 17 patent ductus arteriosus. Each was assigned names using schemes of varying complexity. Using a simple scheme combining origin, type and number of segments supplied (e.g. DTA-SS-3) there are 78 unique names for the 475 MAPCA. With a more complex scheme combining origin, type, number and names of segments supplied (e.g. DTA-SS-3-R1-R2-R6); there are 244 unique names. Once the MAPCA are named, each patient is named by stringing the MAPCA names together. For example, a patient with 3 MAPCA's (DTA-SS-5, DTA-SS-7, DTA-SS-6) is named DTA-SS-5-DTA-SS-7-DTA-SS-6. Even with this relatively simple scheme, 114/128 patients have unique names. These names are converted to a risk score using a formula with weighted factors for origin, type, number of segments, stenoses and maximum number of segments supplied by largest MAPCA. The 128 patients were divided into 5 groups: 1) only dual supply MAPCA, 2) patients with PS, 3) patients with patent ductus arteriosus and MAPCA, 4) combination of dual, single and mixed supply MAPCA and 5) only SS MAPCA. The risk scores for these 5 groups were 1) 19, 2) 26, 3) 41, 4) 50 and 5) 70.
For the individual patient, these naming schemes give a shorthand way to identify each patient, and ensure all relevant data is obtained pre-operatively. For groups of patients, the names and risk scores provide a way to risk-adjust groups and allow comparison of therapeutic approaches and outcomes.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Congenital Catheter Interventions
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1291-122
- 2013 American College of Cardiology Foundation