Biomedical subjects

Daiva Kumpikaite

Publications and source records attributed to Daiva Kumpikaite.

2 recordsLinked to original sources

PubMed2006

Comprehensive Aristotle score: implications for the Norwood procedure.

BACKGROUND: Aristotle score is emerging as a reliable tool to measure surgical performance. We estimated the comprehensive Aristotle score for the Norwood procedure, correlated it with survival, and considered its impact on surgical management of hypoplastic left heart syndrome. METHODS: Comprehensive Aristotle score was retrospectively calculated for 39 consecutive Norwood procedures performed from 2001 to 2004. Survival was estimated by the Kaplan-Meier method. RESULTS: The Aristotle scores ranged from 14.5 to 23.5 (mean, 19.12 +/- 2.52; median, 19.5). The score was 20 or greater in 44% (17 of 39) of cases. The most frequent patient-adjusted factors were aortic atresia (n = 16), interrupted aortic arch (n = 9), mechanical ventilation to treat cardiorespiratory failure (n = 19) and shock resolved at time of surgery (n = 13). Hospital mortality was 58.8% (10 of 17) in case of score of 20 or more and 9.1% (2 of 22) for score less than 20 (p = 0.0014). From 2003 on, all patients with a score less than 20 survived. Actuarial estimate of survival at 1 year is 56.2% +/- 7.9% and there have been no late deaths after 1 year. One-year survival is much lower (p = 0.001) for patients with scores of 20 or greater (29.4% +/- 11.05%) compared with those whose scores were less than 20 (77.3% +/- 8.9%). CONCLUSIONS: This study shows significant correlation of comprehensive Aristotle score with hospital mortality and late survival after Norwood palliation. It suggests that operative survival on the order of 90% may be achieved in patients with comprehensive complexity scores of less than 20. Efforts should be devoted to improve survival of high-risk patients (score > or = 20).

Cardiac Surgical Procedures↗

PubMed2005

Repair of truncus arteriosus and aortic arch interruption: outcome analysis.

BACKGROUND: The excellent results for repair of truncus arteriosus reported in some centers have not applied to patients with associated interrupted aortic arch. This work aims at understanding the discrepancy of results in our own experience. PATIENTS AND METHODS: Ten patients among 83 consecutive children with truncus arteriosus repaired from 1987 to September 2004 who had aortic arch interruption were analyzed, with particular emphasis on clinical presentation and outcome. The comprehensive Aristotle complexity score was calculated for each patient. The Kaplan-Meier method was used to estimate survivals. RESULTS: Preoperative mechanical ventilation was necessary in 5 of the 10 patients; 2 of them were moribund. Associated major lesions were as follows: severe (n = 2) and moderate (n = 4) truncal valve regurgitation, coronary artery anomalies (n = 3) and Di-George's syndrome (n = 4). The comprehensive Aristotle score was at least 20 in 6 patients. There were 5 operative deaths (5 of 10); early mortality was 50% (95% confidence limits: 19% to 81%). These deaths occurred in patients with Aristotle score of 20 or greater (5 of 6 = 83%). All 4 patients who had no moderate or severe truncal valve regurgitation survived the intervention. Survival was a low 37.5% +/- 16.1% from 1 year on compared with a high 95.5% +/- 2.5% for the 73 patients without aortic arch interruption. CONCLUSIONS: This study confirms the predictive value of the Aristotle score, hospital mortality being significantly correlated with the highest Aristotle score (p = 0.024). To improve outcome in these high-risk patients, preoperative management should be optimized, repair should not be delayed, and regurgitant truncal valve should be repaired or replaced.

Aorta, Thoracic↗