Wauthy Pierre, Massaut Jacques, Sanoussi Ahmed, Demanet Hélène, Morissens Marielle, Damry Nasroolla, Dessy Hughes, Malekzadeh-Milani Sophie G, Deuvaert Frank E
Department of Cardiac Surgery, Brugmann University Hospital, Bruxelles, Belgium.
Cardiol Young. 2011 Feb;21(1):39-45. doi: 10.1017/S1047951110001332. Epub 2010 Oct 6.
The number of adults with congenital cardiac disease continues to increase, and adult patients are now more numerous than paediatric patients. We sought to identify risk factors for perioperative death and report our results with surgical management of adult patients with congenital cardiac disease. We retrospectively analysed in-hospital data for 244 consecutive adult patients who underwent surgical treatment of congenital cardiac disease in our centre between January, 1998 and December, 2007. The mean patient age was 27.2 plus or minus 11.9 years, 29% were in functional class III or IV, and 25% were cyanosed. Of the patients, half were operated on for the first time. A total of 61% of patients underwent curative operations, 36% a reoperation after curative treatment, and 3% a palliative operation. Overall mortality was 4.9%. Predictive factors for hospital death were functional class, cyanosis, non-sinus rhythm, a history of only palliative previous operation(s), and an indication for palliative treatment. Functional class, cyanosis, type of initial congenital cardiac disease (single ventricle and double-outlet right ventricle), and only palliative previous operation were risk factors for prolonged intensive care stay (more than 48 hours). The surgical management of adult patients with congenital cardiac disease has improved during recent decades. These generally young patients, with a complex pathology, today present a low post-operative morbidity and mortality. Patients having undergone palliative surgery and reaching adulthood without curative treatment present with an increased risk of morbidity and mortality. Univentricular hearts and double-outlet right ventricles were associated with the highest morbidity.
患有先天性心脏病的成年人数量持续增加，目前成年患者比儿科患者更多。我们试图确定围手术期死亡的危险因素，并报告我们对患有先天性心脏病的成年患者进行手术治疗的结果。我们回顾性分析了1998年1月至2007年12月期间在我们中心接受先天性心脏病手术治疗的244例连续成年患者的住院数据。患者的平均年龄为27.2±11.9岁，29%的患者心功能分级为III或IV级，25%的患者有发绀。其中，一半患者是首次接受手术。共有61%的患者接受了根治性手术，36%的患者在根治性治疗后接受了再次手术，3%的患者接受了姑息性手术。总体死亡率为4.9%。医院死亡的预测因素有心功能分级、发绀、非窦性心律、既往仅接受过姑息性手术的病史以及姑息性治疗指征。心功能分级、发绀、初始先天性心脏病类型（单心室和右心室双出口）以及既往仅接受过姑息性手术是重症监护停留时间延长（超过48小时） 的危险因素。近几十年来，患有先天性心脏病的成年患者的手术治疗有所改善。这些通常年轻的患者，病理情况复杂，如今术后发病率和死亡率较低。接受过姑息性手术且成年后未接受根治性治疗的患者，其发病和死亡风险增加。单心室心脏和右心室双出口与最高的发病率相关。
