Cua Clifford L, Thiagarajan Ravi R, Gauvreau Kimberlee, Lai Lillian, Costello John M, Wessel David L, Del Nido Pedro J, Mayer John E, Newburger Jane W, Laussen Peter C
Department of Cardiology, Children's Hospital, Boston, MA, USA.
Pediatr Crit Care Med. 2006 May;7(3):238-44. doi: 10.1097/01.PCC.0000201003.38320.63.
Previous publications using nonconcurrent series of patients indicate improved survival for patients with hypoplastic left heart syndrome (HLHS) undergoing stage I palliation with a right ventricle to pulmonary artery conduit (NW-RVPA) vs. a modified Blalock-Taussig shunt (NW-BT). We compared postoperative outcomes in a concurrent series of patients with HLHS undergoing an NW-BT procedure vs. NW-RVPA procedure.
Perioperative data from 66 consecutive patients who underwent NW-BT (n = 37) or NW-RVPA (n = 29) procedures were retrospectively analyzed.
Cardiac intensive care unit in a tertiary pediatric hospital.
Charts were reviewed for all patients with the diagnosis of HLHS undergoing the NW-BT or NW-RVPA procedure between January 2002 and December 2003.
Cardiopulmonary bypass time was longer in the NW-BT group than in the NW-RVPA group (152.5 +/- 52.0 vs. 134.5 +/- 36.1 mins; p = .04). Postoperative diastolic pressures were higher and the Pao2 to Fio2 ratio profiles were lower for the NW-RVPA group over the first 72 hrs. Time to sternal closure (2 [1-6] vs. 4 [2-41] days; p = .01), duration of mechanical ventilation (113 [49-386] vs. 136 [84-764] hrs; p = .01), time to establish enteral feeds (4 [2-8] vs. 5 [3-22] days; p = .01), length of intensive care unit stay (11 [7-55] vs. 15 [8-90] days; p = .04), and length of hospital stay (16 [11-67] vs. 27 [12-126] days; p = .01) were shorter in the NW-RVPA group. Postoperative mortality was not significantly different between the NW-RVPA group (7%) and NW-BT group (11%).
At an experienced institution with low stage I palliation mortality for HLHS, there were no differences in early morbidity and mortality between the NW-RVPA and NW-BT procedures. The primary advantage of the NW-RVPA procedure may be faster recovery following surgery and earlier discharge from the hospital.
以往使用非同期患者系列的出版物表明，与改良布莱洛克 - 陶西格分流术（NW - BT）相比，采用右心室至肺动脉导管（NW - RVPA）进行一期姑息治疗的左心发育不全综合征（HLHS）患者生存率有所提高。我们比较了同期接受NW - BT手术与NW - RVPA手术的HLHS患者的术后结局。
对66例连续接受NW - BT（n = 37）或NW - RVPA（n = 29）手术患者的围手术期数据进行回顾性分析。
一家三级儿科医院的心脏重症监护病房。
回顾了2002年1月至2003年12月期间所有诊断为HLHS并接受NW - BT或NW - RVPA手术患者的病历。
NW - BT组的体外循环时间比NW - RVPA组长（152.5±52.0对134.5±36.1分钟；p = 0.04）。在术后头72小时内，NW - RVPA组的术后舒张压较高，而氧分压与吸入氧浓度比值曲线较低。NW - RVPA组的胸骨闭合时间（2 [1 - 6]对4 [2 - 41]天；p = 0.01）、机械通气时间（113 [49 - 386]对136 [84 - 764]小时；p = 0.01）、建立肠内营养的时间（4 [2 - 8]对5 [3 - 22]天；p = 0.01）、重症监护病房住院时间（11 [7 - 55]对15 [8 - 90]天；p = 0.04）和住院时间（16 [11 - 67]对27 [12 - 126]天；p = 0.01）均较短。NW - RVPA组（7%）和NW - BT组（11%）的术后死亡率无显著差异。
在一家一期姑息治疗HLHS死亡率较低的经验丰富的机构中，NW - RVPA和NW - BT手术在早期发病率和死亡率方面没有差异。NW - RVPA手术的主要优势可能是术后恢复更快且出院更早。
