Related Experiment Video
Updated: May 7, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Association between Technical Performance Scores and neurodevelopmental outcomes after congenital cardiac surgery
Meena Nathan1, Anjali Sadhwani2, Kimberlee Gauvreau3
1Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Insights
Technical Performance Score (TPS) impacts infant neurodevelopment after heart surgery. Major residual lesions (TPS class 3) are linked to lower cognitive and motor scores in children.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Outcomes
- Congenital Heart Surgery
Background:
- Technical Performance Score (TPS) correlates with outcomes in congenital cardiac surgery.
- Major residual lesions (TPS class 3) are associated with increased morbidity and reintervention.
- The impact of TPS on neurodevelopmental outcomes in infants is not well understood.
Purpose of the Study:
- To investigate the association between Technical Performance Score (TPS) and neurodevelopmental outcomes in infants following cardiac surgery.
- To determine if TPS class predicts neurodevelopmental performance at one year of age.
Main Methods:
- Infants undergoing cardiac surgery (excluding trisomy 21) received neurodevelopmental testing at one year using Bayley Scales of Infant Development, 3rd edition.
- Discharge echocardiograms were used to grade TPS as class 1 (optimal), 2 (minor residual), or 3 (major residual).
- Multivariate regression analysis was employed, incorporating patient characteristics and preoperative variables.
Main Results:
- Neurodevelopmental testing was completed in 140 patients; 28% had single ventricle palliation and 28% were in Risk Adjustment for Congenital Heart Surgery categories 4-6.
- Patients in TPS class 3 demonstrated significantly lower cognitive (P=.01) and motor (P=.05) composite scores.
- Multivariate analysis confirmed TPS class 3 as an independent predictor of lower Bayley cognitive scores (P=.02) and a trend towards lower motor scores (P=.08).
Conclusions:
- Technical Performance Score (TPS) is an independent predictor of neurodevelopmental outcomes in infants after heart surgery.
- Higher TPS classes, indicating major residual lesions, are associated with poorer neurodevelopmental performance.
- Further research is warranted to explore intraoperative interventions to improve TPS and subsequent neurodevelopmental outcomes.
Objectives:
Technical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes.
Methods:
All infants undergoing cardiac surgery, excluding those with trisomy 21, were offered neurodevelopmental testing at 1 year of age using the Bayley Scales of Infant Development, 3rd edition. TPSs from the discharge echocardiograms were graded as class 1 (optimal), class 2 (minor residual), or class 3 (major residual). Multivariate regression analysis was performed using patient characteristics and preoperative variables.
Results:
Neurodevelopmental testing was performed in 140 patients at a median age of 16 months. Of these, 28 (20%) had single ventricle palliation; 39 (28%) were in Risk Adjustment for Congenital Heart Surgery category 4 to 6. Significant differences between the groups were found in the cognitive (P = .01) and motor (P = .05) domains, with subjects in TPS class 3 having significantly lower cognitive and motor composite scores. The scores did not vary significantly according to single ventricle versus biventricular repair or Risk Adjustment for Congenital Heart Surgery categorization. In multivariate modeling, class 3 TPS remained significantly associated with a lower Bayley cognitive score (P = .02), with a trend toward a lower Bayley motor score (P = .08).
Conclusions:
We found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes.
