Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
Ann Thorac Surg. 2018 May;105(5):1455-1460. doi: 10.1016/j.athoracsur.2017.11.046. Epub 2017 Dec 19.
The comprehensive stage 2 procedure (CS2) follows initial hybrid stage 1 palliation for patients with single-ventricle physiology. The goal of this study was to describe CS2 outcomes and differences between survivors of CS2 (s-CS2) and nonsurvivors (nons-CS2).
All patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent CS2 as index operation from 2010 to 2016 were included. Preoperative, operative, and postoperative data were analyzed, stratified by operative mortality (in-hospital or within 30 days of the operation), with univariate comparisons using χ, Fisher exact, or Wilcoxon rank sum tests.
Of 209 patients (49 centers) who met inclusion criteria, 141 patients had the diagnosis of hypoplastic left heart syndrome. Overall operative mortality was 12.4% (26 of 209). s-CS2 had a lower prevalence of preoperative extracorporeal membrane oxygenation use (0.0% vs 7.7%, p = 0.02) and less frequently underwent concomitant tricuspid valve procedures at the time of the operation (1.1% vs 11.5%, p = 0.01) than nons-CS2. Postoperatively, the prevalence of any of six The Society of Thoracic Surgeons Congenital Heart Surgery Database major complications was higher in nons-CS2 than in s-CS2 (53.9% vs 23.0%, p < 0.01), including a higher prevalence of renal failure (7.7% vs 0.6%, p = 0.04) and postoperative extracorporeal membrane oxygenation use (46.2% vs 2.7%, p < 0.01). There were no other preoperative, operative, or postoperative differences between the two groups.
Operative mortality associated with the CS2 procedure is substantial, especially for patients receiving extracorporeal membrane oxygenation support after CS2. No obvious modifiable variables were noted between patients who died and those who survived.
对于单心室生理患者，综合二期手术（CS2）紧随初始杂交一期姑息治疗之后。本研究的目的是描述 CS2 结果，并比较 CS2 幸存者（s-CS2）和非幸存者（nons-CS2）之间的差异。
纳入 2010 年至 2016 年期间在胸外科医师学会先天性心脏病数据库中接受 CS2 作为索引手术的所有患者。分析术前、术中和术后数据，根据手术死亡率（住院期间或术后 30 天内）进行分层，使用卡方检验、Fisher 确切检验或 Wilcoxon 秩和检验进行单变量比较。
在符合纳入标准的 209 例患者（49 个中心）中，141 例患者被诊断为左心发育不全综合征。总体手术死亡率为 12.4%（26/209）。s-CS2 术前体外膜肺氧合使用率较低（0.0% vs 7.7%，p=0.02），同期行三尖瓣手术的比例较低（1.1% vs 11.5%，p=0.01）。术后，nons-CS2 比 s-CS2 更容易出现六种胸外科医师学会先天性心脏病数据库主要并发症中的任何一种（53.9% vs 23.0%，p<0.01），包括更高的肾衰竭发生率（7.7% vs 0.6%，p=0.04）和术后体外膜肺氧合使用率（46.2% vs 2.7%，p<0.01）。两组之间没有其他术前、术中和术后差异。
CS2 手术相关的手术死亡率相当高，尤其是对于 CS2 后接受体外膜肺氧合支持的患者。在死亡和存活的患者之间没有注意到明显的可改变的变量。
