Analysis of Risk Factors for Early Mortality in Surgical Shunt Palliation: Time for a Change?

IF 0.3 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Congenital Heart Disease Pub Date : 2023-01-01 DOI:10.32604/chd.2023.042344

François-Xavier Van Vyve, Karlien Carbonez, Jelena Hubrechts, Geoffroy de Beco, Jean E. Rubay, Mona Momeni, Thierry Detaille, Alain J. Poncelet

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引用次数: 0

Abstract

Objectives: Over the last decade, neonatal repair has been advocated for many congenital heart diseases. However, specific subgroups of complex congenital heart disease still require temporary palliation for which both surgical and endovascular techniques are currently available. We reviewed our institutional experience with shunt palliation with an emphasis on risk factors for early mortality. Methods: This is a single-center retrospective study on 175 patients undergoing surgery for central shunt or modified Blalock-Taussig shunt. All data were extracted from a prospectively collected computerized database. We identified risk factors for early mortality by uni- and multi-variable analysis. All data were censored at the time of death or shunt take-down operation. Results: Mean age and weight at surgery were 24 days (IQR [7–95]) and 3.4 kg (IQR [2.9–4.8]), respectively, with 96 neonates (55%). Most patients had a biventricular heart disease (115 patients, 66%), and 51 patients (29.1%) had univentricular heart disease. Thoracotomy was performed in 129 patients (74%). Cardiopulmonary bypass was used in 23 patients (13%). The median intensive care and overall length of stay were 4 days (IQR [2–9]) and 18 days (IQR [13–29]), respectively. In-hospital mortality was 8.6% (15/175). By multivariable regression analysis, prematurity (HR 5.6 [2.1–14.7]), CPB use (HR 6.7 [2.2–18.6]), unplanned <30-day reoperation (HR 3.5 [1.2–10]) or catheterization (HR 4.5 [1.2–16.9]) were all significant predictors of early mortality. Conclusions: Procedural-related mortality remains high (8.6%) in surgical shunt palliation. For patients with prematurity, low weight at birth, or if the use of cardiopulmonary bypass is contemplated, alternative endovascular techniques of palliation should be considered together with longitudinal follow-up studies.

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外科分流姑息术早期死亡的危险因素分析:是时候改变了?

目的:在过去的十年中，新生儿修复被提倡用于许多先天性心脏病。然而，复杂先天性心脏病的特定亚群仍然需要暂时的缓解，目前可以使用手术和血管内技术。我们回顾了我们在分流姑息治疗方面的机构经验，重点是早期死亡的危险因素。方法:这是一项单中心回顾性研究，175例接受中央分流术或改良Blalock-Taussig分流术手术的患者。所有数据均从前瞻性收集的计算机数据库中提取。我们通过单变量和多变量分析确定了早期死亡的危险因素。在死亡或分流拆除操作时，所有数据都被删除。结果:手术时平均年龄24天(IQR[7-95])，平均体重3.4 kg (IQR[2.9-4.8])，新生儿96例(55%)。大多数患者患有双室心脏病(115例，66%)，51例(29.1%)患有单室心脏病。129例(74%)患者行开胸手术。体外循环23例(13%)。重症监护的中位数和总住院时间分别为4天(IQR[2-9])和18天(IQR[13-29])。住院死亡率为8.6%(15/175)。通过多变量回归分析，早产(HR 5.6 [2.1-14.7])， CPB使用(HR 6.7[2.2-18.6])，计划外结论:手术相关死亡率仍然很高(8.6%)。对于早产、出生时体重过轻或考虑使用体外循环的患者，应考虑采用其他血管内缓解技术并进行纵向随访研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Congenital Heart Disease CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

0.40

自引率

33.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Congenital Heart Disease is an open-access journal focusing on congenital heart disease in children and adults. Though the number of infants born with heart disease each year is relatively small (approximately 1% of the population), advances in treating such malformations have led to increased life spans for this population. Consequently, today most patients treated for congenital heart disease are over the age of 20. What are the special needs of adults with congenital heart disease? What are the latest developments in the care of the fetus, infants, and children? Who should treat these patients? How should they be treated? Congenital Heart Disease focuses on these questions and more. Conceived as a forum for the most up-to-date information on congenital heart disease, the journal is led by Editor-in-Chief Vladimiro L. Vida, MD, Ph.D., Professor in Cardiac Surgery, University of Padua in Italy, as well as an international editorial board. Congenital Heart Disease publishes articles on heart disease as it relates to the following areas: • Basic research of congenital heart disease • Clinical pediatric and adult cardiology • Cardiac imaging • Preventive cardiology • Diagnostic and interventional cardiac catheterization • Electrophysiology • Surgery • Long-term follow-up, particularly as it relates to older children and adult congenital heart disease • Exercise and exercise physiology in the congenital patient • Post-op and critical care • Common disorders such as syncope, chest pain, murmurs, as well as acquired disorders such as Kawasaki syndrome The journal includes clinical studies, invited editorials, state-of-the-art reviews, case reports, articles focusing on the history and development of congenital heart disease, and CME material. Occasional issues focus on special topics. Readership: Congenital Heart Disease was created for pediatric cardiologists; adult cardiologists who care for patients with congenital heart disease; pediatric and pediatric cardiology nurses; surgeons; radiologists; anesthesiologists; critical care physicians and nurses; and adult support staff involved in the care of patients with congenital heart disease.