Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2014 Jul;148(1):232-237.e3. doi: 10.1016/j.jtcvs.2013.08.032. Epub 2013 Sep 29.
Technical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes.
All infants undergoing cardiac surgery, excluding those with trisomy 21, were offered neurodevelopmental testing at 1 year of age using the Bayley Scales of Infant Development, 3rd edition. TPSs from the discharge echocardiograms were graded as class 1 (optimal), class 2 (minor residual), or class 3 (major residual). Multivariate regression analysis was performed using patient characteristics and preoperative variables.
Neurodevelopmental testing was performed in 140 patients at a median age of 16 months. Of these, 28 (20%) had single ventricle palliation; 39 (28%) were in Risk Adjustment for Congenital Heart Surgery category 4 to 6. Significant differences between the groups were found in the cognitive (P = .01) and motor (P = .05) domains, with subjects in TPS class 3 having significantly lower cognitive and motor composite scores. The scores did not vary significantly according to single ventricle versus biventricular repair or Risk Adjustment for Congenital Heart Surgery categorization. In multivariate modeling, class 3 TPS remained significantly associated with a lower Bayley cognitive score (P = .02), with a trend toward a lower Bayley motor score (P = .08).
We found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes.
技术性能评分（TPS）与先天性心脏手术后的早期和晚期结果密切相关，具有较大的残余病变（TPS 等级 3）的儿童发病率和再干预率更高。我们试图探讨 TPS 对神经发育结果的影响。
所有接受心脏手术的婴儿（不包括 21 三体综合征患儿）在 1 岁时接受神经发育测试，使用贝利婴幼儿发展量表第 3 版。根据出院超声心动图将 TPS 分级为 1 级（最佳）、2 级（轻微残余）或 3 级（主要残余）。使用患者特征和术前变量进行多变量回归分析。
140 名患者在中位年龄 16 个月时进行了神经发育测试。其中，28 例（20%）接受了单心室姑息治疗；39 例（28%）为先天性心脏病风险调整 4 至 6 类。各组间认知（P=.01）和运动（P=.05）领域存在显著差异，TPS 等级 3 的患者认知和运动综合评分明显较低。单心室与双心室修复或先天性心脏病风险调整分类之间的评分无显著差异。在多变量建模中，3 级 TPS 与较低的贝利认知评分显著相关（P=.02），与较低的贝利运动评分呈趋势相关（P=.08）。
我们发现 TPS 是婴儿心脏手术后神经发育结果的独立预测因子。未来的研究应探讨术中识别和干预残余病变的结构化方案是否可以改善 TPS 和神经发育结果。
