阶段 1 杂交姑息治疗左心发育不良综合征——当代应用模式评估：对胸外科医生学会先天性心脏外科学数据库的分析。
Stage 1 hybrid palliation for hypoplastic left heart syndrome--assessment of contemporary patterns of use: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.
机构信息
Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California San Francisco, San Francisco, Calif.
Division of Cardiovascular Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn.
出版信息
J Thorac Cardiovasc Surg. 2015 Jan;149(1):195-201, 202.e1. doi: 10.1016/j.jtcvs.2014.08.020. Epub 2014 Aug 14.
OBJECTIVE
Hybrid palliation is an alternative to Norwood stage 1 for the initial management of hypoplastic left heart syndrome. Contemporary multicenter hybrid use and institutional/patient factors associated with hybrid use relative to the Norwood have not been evaluated. We describe hybrid use in relation to institutional volume, patient factors, and short-term outcomes.
METHODS
Infants aged 60 days or less listed in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2012) undergoing initial palliation of hypoplastic left heart syndrome were included. Annual institutional hybrid use rates were calculated: [hybrid procedures/(Norwood + hybrid + transplant procedures)]. In-hospital outcomes for primary hybrid and primary Norwood were compared and stratified by high (defined as ≥50%) versus low (defined as ≤10%) institutional hybrid use.
RESULTS
Of 1728 patients (100 centers), most (n = 1496, 87%) underwent an index Norwood; 232 patients (13%) underwent an index hybrid procedure. Preoperative patient risk factors were more prevalent in patients undergoing the hybrid procedure. Only 13 of 100 institutions were high hybrid users, and these tended to have lower annual hypoplastic left heart syndrome index case volume. Unadjusted in-hospital mortality was higher for the hybrid compared with the Norwood procedure (30% vs 16%; P < .001). In-hospital mortality for the hybrid procedure was not associated with hybrid use (26% among institutions with low use vs 28% among institutions with high use). However, centers with high hybrid use had higher mortality after the Norwood (43%) compared with centers with low hybrid use (16%).
CONCLUSIONS
Few centers currently select the hybrid procedure for most infants with hypoplastic left heart syndrome. Although unadjusted in-hospital hybrid mortality is higher than Norwood mortality, potential risk factors are more prevalent among hybrid cases. Institutions with higher hybrid use have lower hypoplastic left heart syndrome case volume and higher Norwood mortality.
目的
Hybrid palliation 是一种替代 Norwood Ⅰ期手术的方法，用于治疗左心发育不良综合征。目前尚未评估多中心 hybrid 使用以及与 Norwood 相比与 hybrid 使用相关的机构/患者因素。我们描述了与机构数量、患者因素和短期结果相关的 hybrid 使用。
方法
纳入了在胸外科医师学会先天性心脏病数据库（2010-2012 年）中登记的 60 天或以下的患有左心发育不良综合征的婴儿，接受初始姑息治疗。计算每年的机构 hybrid 使用率：[hybrid 程序/（Norwood + hybrid + 移植程序）]。比较了原发性 hybrid 和原发性 Norwood 的住院结果，并根据高（定义为≥50%）和低（定义为≤10%）机构 hybrid 使用进行分层。
结果
在 1728 名患者（100 个中心）中，大多数（n=1496，87%）接受了指数 Norwood 手术；232 名患者（13%）接受了指数 hybrid 手术。接受 hybrid 手术的患者术前风险因素更为常见。只有 13 个中心是 high hybrid 用户，这些中心的左心发育不良综合征指数病例年度容量较低。与 Norwood 手术相比，hybrid 手术的住院死亡率更高（30% vs 16%；P<0.001）。hybrid 手术的住院死亡率与 hybrid 使用无关（低使用机构为 26%，高使用机构为 28%）。然而，high hybrid 使用的中心在接受 Norwood 手术后的死亡率更高（43%比 low hybrid 使用的中心高 16%）。
结论
目前，很少有中心选择 hybrid 手术治疗大多数患有左心发育不良综合征的婴儿。尽管未经调整的 hybrid 住院死亡率高于 Norwood 死亡率，但 hybrid 病例中更常见潜在的危险因素。使用 hybrid 较多的机构左心发育不良综合征病例量较低，Norwood 死亡率较高。
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