Surendran Sushitha, Kumar T K Susheel, Tansey Ben, Allen Jerry, Zurakowski David, Boston Umar, Shah Samir H, Knott-Craig Christopher J
1Department of Pediatrics,Division of Pediatric Cardiology,University of Tennessee Health Science Center,Le Bonheur Children's Hospital,Memphis,Tennessee,United States of America.
2Department of Pediatric Cardiothoracic Surgery,University of Tennessee Health Science Center,Le Bonheur Children's Hospital,Memphis,Tennessee,United States of America.
Cardiol Young. 2017 Nov;27(9):1778-1785. doi: 10.1017/S1047951117001299. Epub 2017 Jun 27.
Numerous advances in surgical techniques and understanding of single-ventricle physiology have resulted in improved survival. We sought to determine the influence of various demographic, perioperative, and patient-specific factors on the survival of single-ventricle patients following stage 1 palliation at our institution.
We conducted a retrospective study of all single-ventricle patients who had undergone staged palliation at our institution over an 8-year period. Data were collected from the Society of Thoracic Surgeons Congenital Heart Surgery database and from patient charts. Information on age, weight at stage 1 palliation, prematurity, genetic abnormalities, non-cardiac anomalies, ventricular dominance, and type of palliation was collected. Information on mortality and unplanned reinterventions was also collected.
A total of 72 patients underwent stage 1 palliation over an 8-year period. There were 12 deaths before and one death after stage 2 palliation. There was no hospital mortality following Glenn or Fontan procedures. On univariate analysis, low weight at the time of stage 1 palliation and prematurity were found to be risk factors for mortality following stage 1 palliation. However, multivariable Cox regression analysis revealed weight at stage 1 palliation to be a strong predictor of mortality. The type of stage 1 palliation did not have any influence on the outcome. No difference in survival was noted following the Glenn procedure.
Low weight has a deleterious impact on survival following stage 1 palliation. This is mitigated by stage 2 palliation. The type of stage 1 palliation itself has no bearing on the outcome.
手术技术和对单心室生理学认识的诸多进展已使生存率提高。我们试图确定各种人口统计学、围手术期及患者特异性因素对我院单心室患者一期姑息治疗后生存情况的影响。
我们对我院8年间接受分期姑息治疗的所有单心室患者进行了一项回顾性研究。数据收集自胸外科医师协会先天性心脏病手术数据库及患者病历。收集了关于年龄、一期姑息治疗时的体重、早产、基因异常、非心脏畸形、心室优势及姑息治疗类型的信息。还收集了死亡率及非计划再次干预的信息。
8年间共有72例患者接受了一期姑息治疗。二期姑息治疗前有12例死亡，二期姑息治疗后有1例死亡。格林手术或Fontan手术后无院内死亡。单因素分析发现，一期姑息治疗时体重低和早产是一期姑息治疗后死亡的危险因素。然而，多变量Cox回归分析显示，一期姑息治疗时的体重是死亡的有力预测因素。一期姑息治疗的类型对结局无任何影响。格林手术后生存率无差异。
低体重对一期姑息治疗后的生存有有害影响。二期姑息治疗可减轻这种影响。一期姑息治疗的类型本身对结局无影响。
