Chittithavorn Voravit, Duangpakdee Pongsanae, Rergkliang Chareonkiat, Pruekprasert Napat
Division of Cardiothoracic Surgery, Faculty of Medicine, Department of Surgery, Prince of Songkla University, Songkhla, Thailand.
Interact Cardiovasc Thorac Surg. 2017 Sep 1;25(3):407-413. doi: 10.1093/icvts/ivx147.
To determine the association between several perioperative variables and in-hospital shunt thrombosis and mortality in patients weighing less than 3 kg with functional univentricular heart (UVH) who underwent modified Blalock-Taussig shunt.
Between January 2006 and February 2016, 85 patients who weighed less than 3 kg with functional UVH and underwent modified Blalock-Taussig shunt were reviewed. In-hospital shunt thrombosis and mortality were the primary outcomes. The associations between perioperative variables and outcomes were assessed with univariate and multivariate analyses.
In-hospital shunt thrombosis was 14% (12 of 85). Hospital mortality was 18% (15 of 85), which resulted in an 82% discharge survival rate. Shunt thrombosis was significantly associated with in-hospital mortality (odds ratio 18.9, 95% confidence interval 4.5-78.9). There were no statistically significant associations between weight, specific diagnosis of functional UVH and shunt thrombosis or mortality. Multivariate analysis identified delayed initiation of anticoagulant (P < 0.01) and postoperative cardiac arrest (P < 0.01) as risk factors of shunt thrombosis, while intraoperative bradycardia (P < 0.01), high postoperative haemoglobin (P = 0.03) and shunt thrombosis (P < 0.01) were risk factors for hospital mortality.
In this high-risk group of patients who weighed less than 3 kg with functional UVH and who underwent modified Blalock-Taussig shunt, in-hospital mortality was strongly associated with the occurrence of shunt thrombosis. Our study highlighted the perioperative variables of delayed postoperative initiation of anticoagulant, cardiac arrest and the occurrence of intraoperative bradycardia that were significant risk factors for shunt thrombosis and mortality. Achieving better quality of perioperative care potentially improves outcomes.
确定体重小于3千克、患有功能性单心室心脏（UVH）且接受改良布莱洛克-陶西格分流术的患者的几种围手术期变量与院内分流血栓形成及死亡率之间的关联。
回顾2006年1月至2016年2月期间85例体重小于3千克、患有功能性UVH且接受改良布莱洛克-陶西格分流术的患者。院内分流血栓形成和死亡率为主要结局。采用单因素和多因素分析评估围手术期变量与结局之间的关联。
院内分流血栓形成率为14%（85例中的12例）。医院死亡率为18%（85例中的15例），出院生存率为82%。分流血栓形成与院内死亡率显著相关（比值比18.9，95%置信区间4.5 - 78.9）。体重、功能性UVH的具体诊断与分流血栓形成或死亡率之间无统计学显著关联。多因素分析确定抗凝剂启动延迟（P < 0.01）和术后心脏骤停（P < 0.01）为分流血栓形成的危险因素，而术中心动过缓（P < 0.01）、术后高血红蛋白（P = 0.03）和分流血栓形成（P < 0.01）为医院死亡率的危险因素。
在这组体重小于3千克、患有功能性UVH且接受改良布莱洛克-陶西格分流术的高危患者中，院内死亡率与分流血栓形成的发生密切相关。我们的研究强调了术后抗凝剂启动延迟、心脏骤停和术中心动过缓的围手术期变量是分流血栓形成和死亡率的重要危险因素。实现更好的围手术期护理质量可能会改善结局。
