From the Department of Surgery and Cardiology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Circulation. 2015 Jan 27;131(4):347-53; discussion 353. doi: 10.1161/CIRCULATIONAHA.114.011190. Epub 2014 Dec 23.
Surgical treatment of congenital cardiac defects in Finland started >60 years ago. We analyzed the survival of all the pediatric cardiac surgery patients operated on before 2010.
Data were obtained retrospectively from a pediatric cardiac surgery database. Patient status was received from the Finnish Population Registry. Survival was determined with the Kaplan-Meier method, and the survival rate was compared with a sex- and age-matched general population. Between 1953 and 2009, 13 876 cardiac operations were performed on 10 964 pediatric patients in Finland. Follow-up coverage was 98%. The 60-year survival for the entire study was 70% versus 86% for the general population. The number and proportion of severe cardiac defects increased in the 2000s. The long-term survival of patients with severe defects improved significantly across decades. For instance, the 22-year survival rate of patients with transposition of the great arteries operated on in 1953 to 1989 and in 1990 to 2009 improved from 71% to 93% (hazard ratio for death, 0.29; 95% confidence interval, 0.17-0.49; P<0.0001), respectively. The mean patient age at operation decreased from 8.9 to 2.2 years (95% confidence interval, 6.2-7.1; P<0.0001). The early mortality of patients decreased from a maximum of 7% in the 1970s to 3% in the 2000s (95% confidence interval, 0.05-0.08; P<0.0001).
Patients are diagnosed and treated at an increasingly younger age. Advanced diagnostics, surgical methods, and postoperative intensive care have led to substantial improvements in both early and late results among pediatric cardiac surgery patients.
芬兰的先天性心脏缺陷外科治疗始于 60 多年前。我们分析了 2010 年以前接受手术的所有儿科心脏手术患者的生存情况。
数据从儿科心脏手术数据库中回顾性获得。患者状况从芬兰人口登记处获得。采用 Kaplan-Meier 法确定生存率，并将生存率与性别和年龄匹配的普通人群进行比较。1953 年至 2009 年，芬兰对 10964 名儿科患者进行了 13876 次心脏手术。随访覆盖率为 98%。整个研究的 60 年生存率为 70%，而普通人群为 86%。2000 年代严重心脏缺陷的数量和比例增加。几十年来，严重缺陷患者的长期生存率显著提高。例如，1953 年至 1989 年和 1990 年至 2009 年接受大动脉转位手术的患者 22 年生存率分别从 71%提高到 93%（死亡风险比为 0.29；95%置信区间为 0.17-0.49；P<0.0001）。患者手术时的平均年龄从 8.9 岁降至 2.2 岁（95%置信区间为 6.2-7.1；P<0.0001）。患者的早期死亡率从 20 世纪 70 年代的最高 7%降至 21 世纪 00 年代的 3%（95%置信区间为 0.05-0.08；P<0.0001）。
患者的诊断和治疗年龄越来越小。先进的诊断、手术方法和术后重症监护使儿科心脏手术患者的早期和晚期结果都得到了实质性改善。
