{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:13:06Z","timestamp":1780927986913,"version":"3.54.1"},"reference-count":18,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["World J Pediatr Congenit Heart Surg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Tetralogy of Fallot (TOF) repair is associated with low mortality in high-performance centers, but outcomes are worse in low- and middle-income countries (LMICs). Prior studies have not demonstrated a strong link between Technical Performance Score (TPS) and mortality. The aim of this was to evaluate risk factors for mortality and complications after TOF repair in a high-volume LMIC heart center with a focus on surgical performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed children undergoing TOF repair between 2015 and 2022. Patients over two years of age or with complex defects beyond atrial septal defect and persistent ductus arteriosus were excluded. Preoperative factors included age, weight, genetic syndromes, urgency, and pulmonary artery z-scores. Intraoperative variables included transannular patch use, cardiopulmonary bypass and cross-clamp times, surgeon, and TPS classification. Postoperative variables included delayed sternal closure (DSC), extracorporeal membrane oxygenation (ECMO), and Vasoactive Inotropic Score (VIS) during the first 24\u2005h. Outcomes included mortality, complications, and length of stay (LOS). Analyses included logistic regression and Kaplan-Meier estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 255 patients, in-hospital mortality was 7.5% (n\u2009=\u200919). Technical Performance Score class 3 was an independent predictor of mortality (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.027), along with VIS 24\u2005h and ECMO. Cardiopulmonary bypass time, ECMO, and DSC were associated with major complications. Technical Performance Score class 3 correlated with longer LOS, but multivariable analysis identified low weight and ECMO as independent LOS predictors. Five-year survival was worse in TPS class 3 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inadequate TPS is an independent predictor of mortality after TOF repair in an LMIC context. Class 3 TPS also relates to longer hospitalization and worse medium-term survival. Surgical quality remains essential for better outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501351251386433","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T19:10:39Z","timestamp":1769713839000},"page":"441-448","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of Technical Performance Score on Outcomes After Tetralogy of Fallot Repair in a Low-Middle-Income Country"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5806-6780","authenticated-orcid":false,"given":"Leonardo Augusto","family":"Miana","sequence":"first","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meena","family":"Nathan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5740-7707","authenticated-orcid":false,"given":"Valdano","family":"Manuel","sequence":"additional","affiliation":[{"name":"Cardiovascular and Thoracic Service, Complexo Hospitalar de Doen\u00e7as Cardio-Pumonares Cardeal Dom Alexandre do Nascimento, Luanda, Angola e Cardiovascular Surgery, Cl\u00ednica Girassol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davi Freitas","family":"Ten\u00f3rio","sequence":"additional","affiliation":[{"name":"Dell Children's Hospital and Dell Medical School at University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Freitas","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Turquetto","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Amato","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Biscegli","family":"Jatene","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1bio Biscegli","family":"Jatene","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-4-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150135120968103"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2022.12.040"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2014.12.001"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1274913"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.07.031"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1530\/ERP-19-0032"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.05.080"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.14270"},{"issue":"4","key":"e_1_3_2_11_2","first-page":"260","article-title":"Collaborative quality improvement in the congenital heart defects: development of the ASSIST consortium and a preliminary surgical outcomes report","volume":"32","author":"Carmona F","year":"2017","unstructured":"Carmona F, Manso PH, Ferreira MN, et al. Collaborative quality improvement in the congenital heart defects: development of the ASSIST consortium and a preliminary surgical outcomes report. Braz J Cardiovasc Surg. 2017;32(4):260\u2010269.","journal-title":"Braz J Cardiovasc Surg"},{"issue":"3","key":"e_1_3_2_12_2","first-page":"219","article-title":"Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center","volume":"31","author":"Cavalcante CT","year":"2016","unstructured":"Cavalcante CT, de Souza NMG, Pinto VC,Jr, et al. Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center. Braz J Cardiovasc Surg. 2016;31(3):219\u2010225.","journal-title":"Braz J Cardiovasc Surg"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.21470\/1678-9741-2021-0485"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.07.081"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000153"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.02.066"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-19-0800"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00558-8"},{"key":"e_1_3_2_19_2","unstructured":"The Society of Thoracic Surgeons Cardiac Surgery Database: database data collection. Accessed February 3 2024. https:\/\/www.sts.org\/registries-research-center\/sts-national-database\/adultcardiac-surgery-database\/data-collection"}],"container-title":["World Journal for Pediatric and Congenital Heart Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501351251386433","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501351251386433","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501351251386433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:07:41Z","timestamp":1780924061000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501351251386433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":18,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/21501351251386433"],"URL":"https:\/\/doi.org\/10.1177\/21501351251386433","relation":{},"ISSN":["2150-1351","2150-136X"],"issn-type":[{"value":"2150-1351","type":"print"},{"value":"2150-136X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]}}}