Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2021 Oct;112(4):1290-1297. doi: 10.1016/j.athoracsur.2020.07.039. Epub 2020 Sep 25.
The Technical Performance Score (TPS) can predict outcomes after congenital cardiac surgery. We sought to validate TPS as a predictor of both short- and long-term outcomes of the Norwood procedure.
We conducted a retrospective review of patients who underwent the Norwood procedure from 1997 to 2017. We assigned TPS (class 1, no residua; class 2, minor residua; class 3, major residua or reintervention for major residua before discharge) based on subcomponent scores from discharge echocardiograms or unplanned reinterventions, or both. Multivariable Cox or competing risk analysis, adjusted for preoperative patient- and procedure-related covariates, examined the association of TPS with postoperative hospital length of stay, transplant-free survival, and postdischarge reinterventions.
Among 500 patients, 319 (64%) were male, 54 (11%) were premature, 56 (11%) had noncardiac anomalies/syndromes, 146 (29%) had preoperative risk factors, and 480 (96%) were assigned TPS. On multivariable analysis, class 3 had greater hazard for reinterventions in transplant-free survivors (class 3: subdistribution hazard ratio [HR], 2.06; 95% confidence interval [CI] 1.34-3.16; P = .001) and was associated with increased hospital length of stay vs class 1 (HR, 0.25; 95% CI, 0.18-0.34; P < .001). Transplant-free survival after Norwood surgery was shorter for both class 2 (HR, 2.48; 95% CI, 1.68-3.66; P < .001) and class 3 (HR, 3.29; 95% CI, 2.18-4.95; P < .001).
TPS predicts early and late outcomes after Norwood. Absence of residual lesions results in improved long-term prognosis for single-ventricle patients. TPS may improve outcomes after Norwood by identifying patients warranting closer follow-up and potentially earlier reintervention.
技术性能评分（TPS）可预测先天性心脏手术后的结果。我们试图验证 TPS 是否可以预测 Norwood 手术的短期和长期结果。
我们对 1997 年至 2017 年间接受 Norwood 手术的患者进行了回顾性研究。我们根据出院超声心动图或计划外再介入的亚组分值，或两者兼而有之，将 TPS（无残留病变的 1 级，少量残留病变的 2 级，大量残留病变或大量残留病变在出院前需要再次介入的 3 级）分配给患者。多变量 Cox 或竞争风险分析，根据术前患者和手术相关因素进行调整，研究了 TPS 与术后住院时间、无移植生存率和出院后再介入之间的关系。
在 500 例患者中，319 例（64%）为男性，54 例（11%）为早产儿，56 例（11%）有非心脏异常/综合征，146 例（29%）有术前危险因素，480 例（96%）被分配 TPS。多变量分析显示，在无移植幸存者中，3 级的再介入风险更高（3 级：亚分布风险比[HR]，2.06；95%置信区间[CI]，1.34-3.16；P=0.001），与 1 级相比，3 级与住院时间延长有关（HR，0.25；95%CI，0.18-0.34；P<0.001）。Norwood 手术后无移植生存率对 2 级（HR，2.48；95%CI，1.68-3.66；P<0.001）和 3 级（HR，3.29；95%CI，2.18-4.95；P<0.001）患者均较短。
TPS 可预测 Norwood 术后的早期和晚期结果。无残留病变可改善单心室患者的长期预后。通过识别需要密切随访和潜在更早介入的患者，TPS 可能改善 Norwood 手术后的结果。
