Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Ark.
Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Ark.
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1299-305. doi: 10.1016/j.jtcvs.2013.06.019. Epub 2013 Jul 21.
There is cross-center variability with regard to timing repair of non-ductal-dependent tetralogy of Fallot (TOF). We hypothesized that earlier repair in the neonatal period is associated with increased mortality and morbidity.
This was a retrospective analysis of the Pediatric Health Information System of tetralogy of Fallot patients undergoing complete repair from 2004 through 2010 between the ages of 1 day to younger than 19 years. Patients with pulmonary valve atresia, those who received prostaglandin during hospital admission, and those who underwent prior shunt palliation were excluded.
A total of 4698 patients met our inclusion criteria, of whom 202 were younger than 30 days old (group A), 861 were 31 to 90 days old (group B), 1796 were 91 to 180 days old (group C), and 1839 were older than 180 days (group D). In-hospital mortality, intensive care unit length of stay, and total hospital length of stay were significantly higher in group A. Patients in group A had a significantly increased postoperative requirement for mechanical ventilation, intravenous blood pressure support, medical diuresis, extracorporeal membrane oxygenation, gastrostomy tube insertion, heart catheterization, and surgical revision. Significant institutional variability was noted for timing of TOF complete repair, with one third of the centers performing 75% of the repairs at younger than 30 days old. The institutional approach to timing TOF complete repair showed no relation to surgical volume.
Across all centers analyzed, primary neonatal elective TOF repair (<30 days of age) is associated with significantly higher postoperative in-hospital morbidity and mortality, although a few centers have shown an ability to use this strategy with excellent survivability.
非杜氏依赖性法洛四联症（TOF）的修复时机存在跨中心差异。我们假设新生儿期早期修复与死亡率和发病率增加相关。
这是对 2004 年至 2010 年间在 1 天至 19 岁以下接受完全修复的 TOF 患者的小儿健康信息系统的回顾性分析。排除了肺动脉瓣闭锁、住院期间接受前列腺素治疗以及接受过分流姑息治疗的患者。
共有 4698 名患者符合我们的纳入标准，其中 202 名患者年龄小于 30 天（A 组），861 名患者年龄为 31 至 90 天（B 组），1796 名患者年龄为 91 至 180 天（C 组），1839 名患者年龄大于 180 天（D 组）。A 组的住院死亡率、重症监护病房住院时间和总住院时间显著较高。A 组患者术后机械通气、静脉血压支持、药物利尿、体外膜氧合、胃造口管插入、心导管检查和手术修订的需求显著增加。TOF 完全修复的时机存在显著的机构间变异性，三分之一的中心在 30 天以下完成了 75%的修复。TOF 完全修复的机构方法与手术量无关。
在分析的所有中心中，原发性新生儿择期 TOF 修复（<30 天）与术后住院发病率和死亡率显著增加相关，尽管少数中心已经表现出使用这种策略的出色生存能力。
