Tenório Davi Freitas, Miana Leonardo Augusto, Meyer João Guilherme Vidal, Katsuyama Eric Shih, Fukunaga Christian Ken, Turquetto Aida Luiza Ribeiro, Amato Luiza Patrick, Jatene Marcelo Biscegli, Jatene Fabio B
Division of Pediatric Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Division of Surgery, University of Texas at Austin, Austin, Texas, United States of America.
Braz J Cardiovasc Surg. 2025 Jun 18;40(4):e20240442. doi: 10.21470/1678-9741-2024-0442.
The Norwood operation has transformed the approach to hypoplastic left heart syndrome and its variants. Given the complexity of this procedure, postoperative residual injuries are prevalent.
To evaluate the impact of significant residual injuries on clinical outcomes and mortality in Norwood procedure patients at a high-volume tertiary center in a developing nation using the technical performance score (TPS).
This single-center, retrospective study included patients who underwent the Norwood procedure between December 2018 and February 2023. Data on demographics, echocardiograms, complications, intensive care unit stay, and mortality were collected. Logistic regression and linear analyses assessed the impact of TPS on outcomes.
Of 69 patients, nine (13%) were excluded due to incomplete echocardiographic data, leaving 60 (87%) for TPS classification. Among them, 28 (47%) were male. TPS classification was as follows: 40 (66%) in class 1 (excellent), five (8.3%) in class 2 (adequate), and 15 (25%) in class 3 (inadequate), indicating significant residual lesions or need for reintervention. The 30-day mortality rate was 21.6%, increasing to 41.6% before the next stage. In TPS class 3, 30-day mortality was 33% vs. 17% in classes 1 and 2 (P = 0.27). Interstage mortality was 60% in class 3 compared to 35% in other groups (P = 0.13). Major complications were significantly higher in TPS class 3 (93% vs. 55.5%, P = 0.04).
TPS effectively predicts major complications post-Norwood and serves as a valuable tool for improving patient outcomes.
诺伍德手术改变了对左心发育不全综合征及其变异型的治疗方法。鉴于该手术的复杂性，术后残留损伤很常见。
在一个发展中国家的大型三级中心，使用技术性能评分（TPS）评估严重残留损伤对诺伍德手术患者临床结局和死亡率的影响。
这项单中心回顾性研究纳入了2018年12月至2023年2月期间接受诺伍德手术的患者。收集了人口统计学、超声心动图、并发症、重症监护病房住院时间和死亡率的数据。逻辑回归和线性分析评估了TPS对结局的影响。
69例患者中，9例（13%）因超声心动图数据不完整被排除，剩余60例（87%）用于TPS分类。其中，28例（47%）为男性。TPS分类如下：1类（优秀）40例（66%），2类（ adequate）5例（8.3%），3类（不足）15例（25%），表明存在严重残留病变或需要再次干预。30天死亡率为21.6%，在下一阶段前增至41.6%。在TPS 3类中，30天死亡率为33%，而1类和2类为17%（P = 0.27）。3类的阶段间死亡率为60%，其他组为35%（P = 0.13）。TPS 3类的主要并发症显著更高（93%对55.5%，P = 0.04）。
TPS能有效预测诺伍德手术后的主要并发症，是改善患者结局的有价值工具。
