Curzon Christopher L, Milford-Beland Sarah, Li Jennifer S, O'Brien Sean M, Jacobs Jeffrey Phillip, Jacobs Marshall Lewis, Welke Karl F, Lodge Andrew J, Peterson Eric D, Jaggers James
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC 27710, USA.
J Thorac Cardiovasc Surg. 2008 Mar;135(3):546-51. doi: 10.1016/j.jtcvs.2007.09.068. Epub 2008 Jan 18.
The evaluation of operative mortality risk for cardiac surgery in infants with low weight is limited. To determine whether low weight is a risk factor for increased mortality, we reviewed the experience within the Society of Thoracic Surgeons Congenital Heart Surgery Database of infants who have undergone surgical correction or palliation for congenital heart disease.
We analyzed mortality in 3022 infants ages 0 to 90 days weighing 1 to 2.5 kg (n = 517) and greater than 2.5 to 4 kg (n = 2505) who underwent cardiac surgery from 2002 through 2004 at 32 participating centers. Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention. Patients were also analyzed according to Risk Adjustment for Congenital Heart Surgery-1 and Aristotle Basic Complexity scores.
Compared with infants weighing 2.5 to 4 kg, infants weighing less than 2.5 kg had a significantly higher mortality for the following operations: repair of coarctation of the aorta, total anomalous pulmonary venous connection repair, arterial switch procedure, systemic to pulmonary artery shunt, and the Norwood procedure. Lower infant weight remained strongly associated with mortality risk after stratifying the population by Risk Adjustment for Congenital Heart Surgery-1 levels 2 through 6 and Aristotle Basic Complexity levels 2 through 4.
Low weight at the time of surgical intervention is associated with increased mortality in patients undergoing several types of cardiovascular procedures. These data do not allow assessment of specific risks or benefits of any particular treatment strategy. However, they do support the need for prospective analysis of specific treatment strategies for these high-risk patients.
对低体重婴儿心脏手术的手术死亡风险评估有限。为确定低体重是否为死亡率增加的风险因素，我们回顾了胸外科医师协会先天性心脏病手术数据库中接受先天性心脏病手术矫正或姑息治疗的婴儿的相关经验。
我们分析了2002年至2004年期间在32个参与中心接受心脏手术的3022例0至90天的婴儿的死亡率，这些婴儿体重为1至2.5千克（n = 517）以及大于2.5至4千克（n = 2505）。患者根据所进行的主要手术进行分组，并根据手术干预时的体重进行分析。患者还根据先天性心脏病手术风险调整-1和亚里士多德基本复杂性评分进行分析。
与体重2.5至4千克的婴儿相比，体重小于2.5千克的婴儿在以下手术中的死亡率显著更高：主动脉缩窄修复术、完全性肺静脉异位连接修复术、动脉调转术、体肺分流术和诺伍德手术。在根据先天性心脏病手术风险调整-1的2至6级和亚里士多德基本复杂性的2至4级对人群进行分层后，较低的婴儿体重仍然与死亡风险密切相关。
手术干预时的低体重与接受多种心血管手术的患者死亡率增加相关。这些数据无法评估任何特定治疗策略的具体风险或益处。然而，它们确实支持对这些高危患者的特定治疗策略进行前瞻性分析的必要性。
