Larrazabal Luis Alesandro, del Nido Pedro J, Jenkins Kathy J, Gauvreau Kimberlee, Lacro Ronald, Colan Steve D, Pigula Frank, Benavidez Oscar J, Fynn-Thompson Francis, Mayer John E, Bacha Emile A
Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2007 Jan;83(1):179-84. doi: 10.1016/j.athoracsur.2006.07.031.
Although adequacy of repair after congenital heart surgery is a crucial determinant of clinical outcome, there is no current method of assessment. We sought to develop a process to measure the adequacy of repair for a diverse group of congenital heart procedures.
Selected surgical procedures, consisting of repair of ventricular septal defect (VSD), tetralogy of Fallot (TOF), complete common atrioventricular canal (CAVC), and arterial switch operation, were divided into component subprocedures, each of which was assessed separately. Three outcome categories of "optimal," "adequate," and "inadequate" were defined by consensus according to postprocedure echocardiographic assessment. Outcome categories for conduction disturbance were also created. All patients undergoing one of the four procedures in 2004 were identified, and each subprocedure was assessed. Other clinical data were obtained from medical records. Repairs were scored as "optimal" if all attempted subprocedures and conduction were optimal, and "inadequate" if any was inadequate.
A total of 138 procedures were included. VSD repair was done in 46 patients (33%), TOF repair in 33 (24%), arterial switch operation in 36 (26%), and CAVC repair in 23 (17%). Optimal technical score was found in 28 (20%), adequate in 106 (77%), and inadequate in 4 (3%) (2 VSD, 1 TOF, 1 CAVC). Median length of stay was 8 days, and no patients died.
Despite procedural diversity and complexity, technical adequacy of repair can be assessed for congenital heart surgery.
尽管先天性心脏手术后修复的充分性是临床结果的关键决定因素，但目前尚无评估方法。我们试图开发一种流程来衡量多种先天性心脏手术修复的充分性。
选定的外科手术包括室间隔缺损（VSD）修复、法洛四联症（TOF）修复、完全性房室通道（CAVC）修复和动脉调转术，将其分为组成性子程序，每个子程序分别进行评估。根据术后超声心动图评估，通过共识定义了“最佳”“充分”和“不充分”三种结果类别。还创建了传导障碍的结果类别。确定了2004年接受这四种手术之一的所有患者，并对每个子程序进行评估。从病历中获取其他临床数据。如果所有尝试的子程序和传导均为最佳，则修复评分为“最佳”；如果有任何一项不充分，则评分为“不充分”。
共纳入138例手术。46例（33%）患者进行了VSD修复，33例（24%）进行了TOF修复，36例（26%）进行了动脉调转术，23例（17%）进行了CAVC修复。28例（20%）技术评分最佳，106例（77%）充分，4例（3%）不充分（2例VSD，1例TOF，1例CAVC）。中位住院时间为8天，无患者死亡。
尽管手术存在多样性和复杂性，但先天性心脏手术修复的技术充分性仍可评估。
