# Technical Performance Score: A Robust Predictor of Morbidity Following the Norwood Procedure at a Developing Country Institution

## TL;DR

This study shows that a technical performance score after a complex heart surgery predicts complications and outcomes in patients from a developing country.

## Contribution

The study validates the use of the technical performance score in a developing country setting for the Norwood procedure.

## Key findings

- TPS class 3 patients had a 60% interstage mortality rate compared to 35% in other groups.
- Major complications were significantly higher in TPS class 3 patients (93% vs. 55.5%).
- TPS effectively predicts postoperative complications and outcomes after the Norwood procedure.

## Abstract

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.