Gutgesell Howard P, Gibson Jennifer
Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA.
Am J Cardiol. 2002 Apr 1;89(7):842-6. doi: 10.1016/s0002-9149(02)02196-3.
We used the discharge database of the University Hospital Consortium to determine the management and early outcome of neonates with hypoplastic left heart syndrome admitted to member institutions from 1990 to 1999. Of the 2,264 patients, 1,203 underwent a Norwood procedure, with 42% mortality. Cardiac transplantation was performed in 72, with 38% mortality, and 217 (10%) were discharged without any surgical procedure. The proportion of patients managed by the Norwood procedure increased from 43% during the first half of the decade to 59% in the second half, with corresponding decreases in the proportion managed by transplantation or nonintervention. A mortality rate of < or =40% was achieved in all 5 institutions performing >50 Norwood procedures, and by 9 of 40 institutions performing <50. Performance of a Norwood procedure has become the most frequent management for neonates with hypoplastic left heart syndrome. Lower operative mortality rates are generally, but not exclusively, achieved by institutions with high surgical volume.
我们利用大学医院联合会的出院数据库，来确定1990年至1999年期间入住成员机构的左心发育不全综合征新生儿的治疗情况及早期预后。在2264例患者中，1203例接受了诺伍德手术，死亡率为42%。72例接受了心脏移植，死亡率为38%，217例（10%）未接受任何手术即出院。接受诺伍德手术治疗的患者比例从该十年前半期的43%增至后半期的59%，而接受移植或非干预治疗的患者比例相应下降。在所有实施超过50例诺伍德手术的5家机构以及40家实施少于50例手术的机构中的9家，均实现了≤40%的死亡率。诺伍德手术已成为左心发育不全综合征新生儿最常用的治疗方法。一般而言，但并非绝对，手术量高的机构手术死亡率较低。
