Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, The Baylor College of Medicine, Houston, TX, USA.
J Thorac Cardiovasc Surg. 2011 Dec;142(6):1358-66. doi: 10.1016/j.jtcvs.2011.04.043. Epub 2011 Jun 24.
There has been considerable improvement in survival after the first stage of palliation for single-ventricle heart disease. Yet, interstage mortality continues to plague this population. Home monitoring has been proposed to reduce interstage mortality. We review our experience after creation of a Single Ventricle Program.
All infants with a single ventricle heart defect who were admitted to Texas Children's Hospital from the inception of the Single Ventricle Program on September 1, 2007, to January 1, 2010, were included in the Single Ventricle Program cohort. Infants with a single ventricle presenting between January 1, 2002, and August 31, 2007, comprised the pre-Single Ventricle Program group. Anatomic, operative, and postoperative details were noted for all patients. End points included in-hospital death after the first stage of palliation, interstage death (defined as after discharge from the first stage of palliation and before the second stage of palliation), and death or heart transplantation by 1 year of age. Interstage weight gain was also compared.
A total of 137 infants with a single ventricle were included in the pre-Single Ventricle Program cohort, and 93 infants were included in the Single Ventricle Program cohort. Anatomic subtypes were similar between groups. There was significant improvement in rate of interstage weight gain, whereas age at the second stage of palliation was significantly reduced in the Single Ventricle Program group. In-house mortality decreased during the Single Ventricle Program era (P = .021). Interstage mortality did not significantly decrease in the Single Ventricle Program group. However, 1-year transplant-free survival improved during the Single Ventricle Program era (P = .002).
The Single Ventricle Program improved interstage weight gain, thereby allowing for early second-stage palliation at an equivalent patient weight. Interstage mortality was not significantly reduced by our program. However, 1-year transplant-free survival was significantly improved in patients in the Single Ventricle Program.
在单心室心脏病的第一阶段姑息治疗后，生存率有了显著提高。然而，过渡阶段的死亡率仍然困扰着这一人群。家庭监测被提议用于降低过渡阶段的死亡率。我们回顾了在创建单心室计划后的经验。
所有在 2007 年 9 月 1 日单心室计划启动至 2010 年 1 月 1 日期间因单心室心脏缺陷入院的婴儿均纳入单心室计划队列。2002 年 1 月 1 日至 2007 年 8 月 31 日期间出现单心室的婴儿组成单心室前计划组。所有患者的解剖、手术和术后细节均被记录。终点包括第一阶段姑息治疗后的院内死亡、过渡阶段死亡（定义为第一阶段姑息治疗出院后至第二阶段姑息治疗前）、1 岁时死亡或心脏移植。还比较了过渡阶段的体重增加。
共有 137 例单心室婴儿被纳入单心室前计划组，93 例婴儿被纳入单心室计划组。两组的解剖亚型相似。单心室计划组的过渡阶段体重增加率显著提高，而第二阶段姑息治疗的年龄显著降低。单心室计划组的院内死亡率在该计划实施期间有所下降（P=0.021）。单心室计划组的过渡阶段死亡率没有显著降低。然而，在单心室计划实施期间，1 年无移植存活率有所提高（P=0.002）。
单心室计划改善了过渡阶段的体重增加，从而可以在同等患者体重下进行早期的第二阶段姑息治疗。我们的方案并没有显著降低过渡阶段的死亡率。然而，在单心室计划组中，1 年无移植存活率显著提高。
