Technical Performance Score: A Predictor of Outcomes After the Norwood Procedure

Abstract Background 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. Methods We conducted a retrospective review of patients who underwent the Norwood procedure from 1997-2017. We assigned TPS (Class 1, no residua; Class 2, minor residua; Class 3, major residua or reintervention for major residua prior to discharge) based on subcomponent scores from discharge echocardiograms and/or unplanned reinterventions. 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 post-discharge reinterventions (RI). Results Among 500 patients, 319 (64%) were male; 54 (11%) premature; 56 (11%) had noncardiac anomalies/syndromes; 146 (29%) had preoperative risk factors; 480 (96%) were assigned TPS. On multivariable analysis, Class 3 had greater hazard for RI in transplant-free survivors (Class 3: Subdistribution Hazard Ratio [SHR] 2.06, CI 1.34,3.16; p=0.001) and was associated with increased hospital length-of-stay versus Class 1 (Hazard Ratio [HR] 0.25; 95% Confidence Interval (CI) 0.18,0.34; p Conclusions 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.