Department of Pediatric Cardiac Surgery, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Mich.
Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Mich.
J Thorac Cardiovasc Surg. 2014 May;147(5):1573-9. doi: 10.1016/j.jtcvs.2013.07.020. Epub 2013 Aug 26.
The optimal timing for neonatal cardiac surgery is unknown. We aimed to determine the relationship between age at surgery and perioperative outcomes, hypothesizing that earlier intervention would be associated with lower morbidity and mortality.
A retrospective review was performed of neonates who had undergone an arterial switch operation, stage 1 palliation for functional single ventricle, or systemic-to-pulmonary shunt for obstructed pulmonary blood flow from January 1, 2005, to December 31, 2010. The subjects with clinical indications for delayed surgery or prematurity were excluded. Age at surgery was evaluated as both a continuous and a categorical variable. The primary outcome was a composite endpoint of mortality or prolonged intensive care stay.
Of 344 subjects, 286 (77 arterial switch operation, 124 stage 1 palliation, 85 systemic-to-pulmonary shunt) met the inclusion criteria. In each group, age at surgery was not associated with the primary composite endpoint. The patients who died after systemic-to-pulmonary shunt had a median age at surgery of 3 days versus 6 days for the survivors (P = .04). A similar, but nonsignificant, pattern was seen for patients undergoing arterial switch operations (4.5 vs 7 days; P = .09). Earlier surgery was not associated with a reduced duration of vasoactive support, mechanical ventilation, or intensive care unit length of stay in any group. Stage 1 palliation subjects in the upper age quartile (≥8 days) at surgery were less likely to require prolonged mechanical ventilation (P = .03).
Younger age at intervention in the neonatal period was not associated with reduced morbidity or mortality in any procedural subgroup studied. In our cohort, earlier systemic-to-pulmonary shunt for obstructed pulmonary blood flow was associated with a greater likelihood of a poor outcome.
新生儿心脏手术的最佳时机尚不清楚。我们旨在确定手术时龄与围手术期结局之间的关系，假设较早的干预与较低的发病率和死亡率相关。
对 2005 年 1 月 1 日至 2010 年 12 月 31 日期间接受动脉调转手术、功能性单心室一期姑息术或体肺分流术治疗的新生儿进行了回顾性研究。排除有延迟手术或早产临床指征的患者。将手术时龄评估为连续变量和分类变量。主要结局是死亡率或延长重症监护时间的复合终点。
在 344 例患者中，286 例（77 例动脉调转手术、124 例一期姑息术、85 例体肺分流术）符合纳入标准。在每个组中，手术时龄与主要复合终点均无相关性。接受体肺分流术的死亡患者的中位手术时龄为 3 天，而存活患者为 6 天（P=0.04）。动脉调转手术患者也存在类似但无统计学意义的模式（4.5 天 vs 7 天；P=0.09）。在任何一组中，手术时龄较早均与减少血管活性支持、机械通气或重症监护病房住院时间无关。手术时龄处于较高四分位区间（≥8 天）的一期姑息术患者更有可能需要长时间机械通气（P=0.03）。
在新生儿期，干预的年龄较小与任何手术亚组的发病率或死亡率降低均无关。在本队列中，较早的体肺分流术治疗肺血阻塞与较差的结局更相关。
