Zahn Evan M, Dobrolet Nancy C, Nykanen David G, Ojito Jorge, Hannan Robert L, Burke Redmond P
Department of Cardiology, Miami Children's Hospital, Miami, Florida 33155, USA.
J Am Coll Cardiol. 2004 Apr 7;43(7):1264-9. doi: 10.1016/j.jacc.2003.10.051.
The purpose of this study was to examine the safety and efficacy of interventional catheterization performed early after congenital heart surgery.
Transcatheter interventions performed in the early postoperative period are viewed as high risk. To date, there have been limited published data regarding these procedures.
All catheterizations performed within six weeks after congenital heart surgery between August 1995 and January 2001 were retrospectively reviewed. A cardiac anesthesiologist, cardiac intensivist, cardiac surgeon, and operating room team were available for all cases. Interventional procedures were performed based on clinical indications, regardless of the time elapsed from surgery.
Sixty-two patients, median age four months (2 days to 11 years), weight 4.7 kg (2.3 to 45 kg), underwent 66 catheterizations on median postoperative day 9 (0 to 42 days). Thirty-five cases involved 50 interventional procedures. Nine patients required extracorporeal cardiopulmonary support. Success rates by procedure were: angioplasty, 100%; stent implantation, 87%; vascular/septal occlusion, 100%; and palliative pulmonary valvotomy, 75%. Complications included stent migration (one patient), cerebral vascular injury (one patient), and left pulmonary artery stenosis (one patient). Thirty procedures involved angioplasty or stent implantation, including 26 involving a recently created suture line. Suture disruption or trans-mural vascular tears were not observed. There was no procedural mortality. Thirty-day survival for patients undergoing intervention was 83%.
Transcatheter interventions can be successfully performed in the early postoperative period. These procedures can have a positive impact on patient outcome; however, they should be performed only by a pediatric interventional cardiologist supported by a multi-disciplinary team.
本研究旨在探讨先天性心脏手术后早期进行介入导管插入术的安全性和有效性。
术后早期进行的经导管介入治疗被视为高风险操作。迄今为止，关于这些手术的已发表数据有限。
回顾性分析1995年8月至2001年1月期间先天性心脏手术后六周内进行的所有导管插入术。所有病例均有心脏麻醉医生、心脏重症监护医生、心脏外科医生和手术室团队参与。介入手术根据临床指征进行，不考虑手术时间。
62例患者，中位年龄4个月（2天至11岁），体重4.7 kg（2.3至45 kg），术后中位第9天（0至42天）接受了66次导管插入术。35例患者进行了50次介入手术。9例患者需要体外心肺支持。各手术成功率如下：血管成形术为100%；支架植入术为87%；血管/间隔封堵术为100%；姑息性肺动脉瓣切开术为75%。并发症包括支架移位（1例患者）、脑血管损伤（1例患者）和左肺动脉狭窄（1例患者）。30例手术涉及血管成形术或支架植入术，其中26例涉及新形成的缝合线。未观察到缝合线断裂或跨壁血管撕裂。无手术死亡病例。接受介入治疗患者的30天生存率为83%。
经导管介入治疗可在术后早期成功进行。这些手术可对患者预后产生积极影响；然而，仅应由多学科团队支持的儿科介入心脏病专家进行操作。
