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Randomized Controlled Trial
. 2014 Nov;148(5):2208-13, 2214.e1-6.
doi: 10.1016/j.jtcvs.2014.05.076. Epub 2014 Jun 19.

Technical performance score is associated with outcomes after the Norwood procedure

Meena Nathan  1 , Lynn A Sleeper  2 , Richard G Ohye  3 , Peter C Frommelt  4 , Christopher A Caldarone  5 , James S Tweddell  4 , Minmin Lu  6 , Gail D Pearson  7 , J William Gaynor  8 , Christian Pizarro  9 , Ismee A Williams  10 , Steven D Colan  11 , Carolyn Dunbar-Masterson  12 , Peter J Gruber  13 , Kevin Hill  14 , Jennifer Hirsch-Romano  3 , Jeffrey P Jacobs  15 , Jonathan R Kaltman  7 , S Ram Kumar  16 , David Morales  17 , Scott M Bradley  18 , Kirk Kanter  19 , Jane W Newburger  12 ; Pediatric Heart Network Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Technical performance score is associated with outcomes after the Norwood procedure

Meena Nathan et al. J Thorac Cardiovasc Surg. 2014 Nov.

Abstract

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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Figures

Figure 1
Figure 1
Time to first extubation, early mortality and Norwood hospital length of stay by TPS classes. Class 3 subjects had a significantly longer time to first extubation, higher early mortality and longer Norwood hospital length of stay. TPS: Technical Performance Score
See this image and copyright information in PMC

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References

    1. Larrazabal LA, del Nido PJ, Jenkins KJ, Gauvreau K, Lacro S, Colan SD, et al. Measurement of technical performance in congenital heart surgery: A pilot study. Ann Thorac Surg. 2007;83:179–184. - PubMed
    1. Bacha EA, Larrazabal LA, Pigula FA, Gauvreau K, Jenkins KJ, Colan SD, 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. - PubMed
    1. Karamichalis JM, del Nido PJ, Thiagarajan RR, Liu H, Gauvreau K, Pigula FA, et al. Early post-operative severity of illness predicts outcomes following the Stage I Norwood procedure. Ann Thorac Surg. 2011;92:660–665. - PubMed
    1. Nathan M, Karamichalis J, Liu H, del Nido P, Pigula F, Thiagarajan R, et al. Intra-operative adverse events can be compensated in infants after cardiac surgery: A prospective study. J Thorac Cardiovasc Surg. 2011;142:1098–1107. - PubMed
    1. Nathan M, Karamichalis J, Liu H, Emani S, Baird C, Pigula F, et al. Surgical Technical Performance Scores are predictors for late mortality and unplanned reinterventions in infants after cardiac surgery. J Thorac Cardiovasc Surg. 2012;144:1095–1101. - PubMed

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