Meza James M, Jaquiss Robert D B, Anderson Brett R, Moga Michael-Alice, Kirklin James K, Sarris George, Williams William G, McCrindle Brian W
1 John W. Kirklin/David Ashburn Fellow, Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
World J Pediatr Congenit Heart Surg. 2017 Mar;8(2):135-141. doi: 10.1177/2150135116677253.
Mortality through single-ventricle palliation remains high and the effect of the timing of stage 2 palliation (S2P) is not well understood. We investigated current practice patterns in the timing of S2P across two professional societies and compared them to actual practice patterns from two databases of patients who underwent S2P.
A ten-question survey was distributed to the members of the Congenital Heart Surgeons' Society (CHSS) and the European Congenital Heart Surgeons' Association (ECHSA). Results were summarized using descriptive statistics. Surgeon-reported preferences were compared to clinical data from the CHSS Critical Left Ventricular Outflow Tract Obstruction (LVOTO) Registry and the Pediatric Heart Network Single Ventricle Reconstruction (SVR) database.
Overall, 38% (88 of 232) of surgeons from 74 institutions responded, of which 70% (62 of 88) were CHSS members and 30% (26 of 88) were ECHSA members. Surgeons reported performing S2P at a median of five months after stage 1 (interquartile range [IQR]: 4.5-6), with no difference between CHSS and ECHSA surgeons. Surgeons reported performing nonelective S2P at a median of 4.5 months after stage 1 (IQR: 3.5-5.5), again with no difference by society. No difference existed between the surgeon-reported preferences and patient data in the Critical LVOTO and SVR databases for the timing of elective (5 vs 5.1 vs 5.3 months, P = .19) or nonelective S2P (4.5 vs 4.6 vs 4.2 months, P = .06).
There was a remarkable lack of variation in surgeon preferences regarding the timing of S2P. This may represent a natural standardization of practice across congenital heart surgery, which is notable, given the current lack of guidelines regarding the timing of S2P.
单心室姑息治疗的死亡率仍然很高，而二期姑息治疗（S2P）的时机效果尚未得到充分了解。我们调查了两个专业协会在S2P时机方面的当前实践模式，并将其与两个接受S2P患者数据库中的实际实践模式进行比较。
向先天性心脏外科医生协会（CHSS）和欧洲先天性心脏外科医生协会（ECHSA）的成员分发了一份包含十个问题的调查问卷。结果采用描述性统计进行总结。将外科医生报告的偏好与CHSS严重左心室流出道梗阻（LVOTO）登记处和儿科心脏网络单心室重建（SVR）数据库的临床数据进行比较。
总体而言，来自74个机构的38%（232名中的88名）外科医生做出了回应，其中70%（88名中的62名）是CHSS成员，30%（88名中的26名）是ECHSA成员。外科医生报告在一期手术后的中位时间为五个月进行S2P（四分位间距[IQR]：4.5 - 6），CHSS和ECHSA外科医生之间没有差异。外科医生报告在一期手术后的中位时间为4.5个月进行非选择性S2P（IQR：3.5 - 5.5），同样各协会之间没有差异。在Critical LVOTO和SVR数据库中，外科医生报告的择期S2P时机偏好（5 vs 5.1 vs 5.3个月，P = 0.19）或非选择性S2P时机偏好（4.5 vs 4.6 vs 4.2个月，P = 0.06）与患者数据之间没有差异。
外科医生在S2P时机偏好方面明显缺乏差异。这可能代表了先天性心脏手术实践的自然标准化，鉴于目前缺乏关于S2P时机的指南，这一点值得注意。
