Technical performance score is associated with outcomes after the Norwood procedure
Open accessAbstract
Objectives The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial.Methods We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned reinterventions that occurred before discharge from the Norwood hospitalization. Multivariable regression examined the association of the TPS with interval to first extubation, Norwood length of stay, death or transplantation, unplanned postdischarge reinterventions, and neurodevelopment at 14 months old.Results Of 549 patients undergoing a Norwood procedure, 356 (65%) had an echocardiogram adequate to assess atrial septal restriction or arch obstruction or an unplanned reintervention, enabling calculation of the TPS. On multivariable regression, adjusting for preoperative variables, a better TPS was an independent predictor of a shorter interval to first extubation (P=.019), better transplant-free survival before Norwood discharge (P<.001; odds ratio, 9.1 for inadequate vs optimal), shorter hospital length of stay (P<.001), fewer unplanned reinterventions between Norwood discharge and stage II (P=.004), and a higher Bayley II psychomotor development index at 14 months (P=.031). The TPS was not associated with transplant-free survival after Norwood discharge, unplanned reinterventions after stage II, or the Bayley II mental development index at 14 months.Conclusions TPS is an independent predictor of important outcomes after Norwood and could serve as a tool for quality improvement.
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Reinterventions after Stage 1 Norwood palliation are frequently due to recurrent or residual lesions that were addressed during surgery, mainly obstruction of the aortic arch and of the shunt or pulmonary arteries.
“In addition, reinterventions after S1NP are often related to recurrent or residual lesions that were addressed at the time of surgery, primarily aortic arch obstruction and shunt or pulmonary artery obstruction.13, 18, 19”
From Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation: STERN et al. (2017) · cites this paper as [18]
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“Patient with superior technical performance scores have been demonstrated to have improved clinical outcomes.(16,17) In addition, reinterventions after S1NP are often related to recurrent or residual lesions that were addressed at the time of surgery, primarily aortic arch obstruction and shunt or pulmonary artery obs…”
BackgroundHypoplastic Left Heart Syndrome: A Review
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Self-citationApplication of the Boston Technical Performance Score to intraoperative echocardiography
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Self-citation
- Authors
- Nathan, M., Sleeper, L. A., Ohye, R. G., Frommelt, P. C., Caldarone, C. A., Tweddell, J. S., Lu, M., Pearson, G. D., Gaynor, J. W., Pizarro, C., Williams, I. A., Colan, S. D., Dunbar-Masterson, C., Gruber, P. J., Hill, K., Hirsch-Romano, J., Jacobs, J. P., Kaltman, J. R., Kumar, S. R., Morales, D., Bradley, S. M., Kanter, K., & Newburger, J. W.
- Affiliations
- Boston Children's Hospital (US)
- Cytel (United States) (US)
- University of Michigan (US)
- Children's Hospital of Wisconsin (US)
- Hospital for Sick Children (CA)
- National Institutes of Health (US)
- Children's Hospital of Philadelphia (US)
- University of Iowa (US)
- Duke University (US)
- Johns Hopkins University (US)
- Children's Hospital Los Angeles (US)
- Cincinnati Children's Hospital Medical Center (US)
- Medical University of South Carolina (US)
- Emory University (US)
- Corresponding author
- Nathan, Meena
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 148
- Issue
- 5
- Pages
- 2208-2214.e6
- ISSN
- 0022-5223 (ISSN-L)
- PMC
- PMC4253672
- OpenAlex
- W2020439679
- Cited by
- 54
- References
- 33
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 11 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 6 · 2014: 2
- FWCI
- 4.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL068288, HL068279, HL068285, HL068269, HL068270, HL085057, HL068281, HL068290, HL109737, HL068292, HL109781)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- Norwood procedure, single ventricle reconstruction, congenital heart surgery, surgical quality indicators, postoperative reintervention, transplant-free survival, brain development, extubation timing, length of hospital stay, quality improvement
- MeSH terms
- Child Development, Decision Support Techniques, Echocardiography, Heart Defects, Congenital, Humans, Infant, Length of Stay, Neuropsychological Tests, North America, Postoperative Complications, Predictive Value of Tests, Psychomotor Performance, Reoperation, Risk Factors, Time Factors, Reproducibility of Results, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Odds Ratio, Heart Transplantation, Databases, Factual, Treatment Outcome, Risk Assessment, Quality Indicators, Health Care, Kaplan-Meier Estimate, Norwood Procedures, Quality Improvement
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