title: Technical performance score is associated with outcomes after the Norwood procedure.
abstract: OBJECTIVE
  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.
authors.affiliation: Children's Hospital Boston and Harvard Medical School, Boston, Mass. Electronic address: meena.nathan@cardio.chboston.org.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.affiliation: Cytel Inc, Cambridge, Mass.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.affiliation: Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Frommelt
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.affiliation: Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: New England Research Institutes, Watertown, Mass.
authors.forename: Minmin
authors.initials: M
authors.lastname: Lu
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
authors.forename: Gail D
authors.initials: GD
authors.lastname: Pearson
authors.affiliation: Children's Hospital of Philadelphia and University of Pennsylvania Medical School, Philadelphia, Pa.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Nemours Cardiac Center, Wilmington, Del.
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
authors.affiliation: Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY.
authors.forename: Ismee A
authors.initials: IA
authors.lastname: Williams
authors.affiliation: Children's Hospital Boston and Harvard Medical School, Boston, Mass; New England Research Institutes, Watertown, Mass.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.affiliation: Children's Hospital Boston and Harvard Medical School, Boston, Mass.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dunbar-Masterson
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gruber
authors.affiliation: Duke University, Chapel Hill, NC.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hill
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hirsch-Romano
authors.affiliation: Johns Hopkins All Children's Heart Institute, St Petersburg, Fla.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, Calif.
authors.forename: S Ram
authors.initials: SR
authors.lastname: Kumar
authors.affiliation: Cincinnati Children's Medical Center, Cincinnati, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Morales
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: Emory University, Atlanta, Ga.
authors.forename: Kirk
authors.initials: K
authors.lastname: Kanter
authors.affiliation: Children's Hospital Boston and Harvard Medical School, Boston, Mass.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D016009:Chi-Square Distribution; D002657:Child Development; D016208:Databases, Factual; D003661:Decision Support Techniques; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D009656:North America; D058327:Norwood Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011597:Psychomotor Performance; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D012086:Reoperation; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome