Technical Performance Score as Predictor for Post-discharge Reintervention in Valve-Sparing Tetralogy of Fallot Repair

Optimal Timing for Elective Early Primary Repair of Tetralogy of Fallot: Analysis of Intermediate Term Outcomes

“…We have previously demonstrated that optimal technical repair as assessed by TPS for TOF repair can be achieved irrespective of the age or size of the patient [11]. In concordance with prior studies [12,17,18], our study confirms the utility of TPS in predicting the need for reintervention in patients after TOF repair. A residual gradient of less than 20 mmHg is considered optimal (TPS-1), 20 to 40 mm Hg is graded as adequate (TPS-2), and over 40 mm Hg is inadequate (TPS-3) by TPS [16].…”

“…Patients 55 days of age and younger at repair have very similar residual gradients to those repaired over 55 days of age (median [IQR] 13 [5.1 to 25 mm Hg] versus 14 [7.4 to 24 mm Hg]). When stratifying patients by age of 55 days at primary repair and if they had an optimal residual peak RVOT gradient (defined as < 20 mm Hg by TPS) [12,16], the reintervention rate was higher in patients 55 days of age and younger at repair, regardless of their residual RVOT gradient (p ¼ 0.04) ( Table 5).…”

“…Surgical TPS have been useful predictors of reintervention for a wide range of congenital heart defect repairs [17], including repair of TOF [12]. We have previously demonstrated that optimal technical repair as assessed by TPS for TOF repair can be achieved irrespective of the age or size of the patient [11].…”

“…We have previously demonstrated that early primary repair can be safely performed without increased hospital resource utilization [10] and without any compromise in the surgical technical performance scores (TPS) [11]; nevertheless, an association has been identified between inadequate TPS and post-discharge reintervention in repaired TOF patients [12].…”

Revisiting the utility of technical performance scores following tetralogy of Fallot repair

“…Subsequent iterations of the TPS for the subdomains of RVOTO specified an optimal repair as a gradient < 2.2 m/s across the subpulmonary area and a gradient or < 2.0 m/s across the pulmonary valve itself. 3,4 The original description of an optimum status of the right ventricular outflow tract (RVOT) following correction, therefore, may not actually reflect the best physiologic repair. Moreover, whereas the TPS represents an important metric to objectively assess the quality of surgical repairs and has been correlated with specific short-term outcomes, our group, 5 and others, 6 have commented on the limitations of the current TPS.…”