Mowers Katie, Rockefeller Toby, Balzer David, Nicolas Ramzi, Shahanavaz Shabana
Division of Cardiology, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, 1 Children's Place, Saint Louis, MO, 63108, USA.
Pediatr Cardiol. 2018 Apr;39(4):674-681. doi: 10.1007/s00246-018-1805-z. Epub 2018 Jan 12.
Catheter-based interventions in the early post-operative period are performed with caution due to concerns for increased procedural risk, particularly across fresh suture lines. The recently published CRISP scoring system provides prospective risk stratification based on pre-procedural criterion. In an effort to refine the assessment of risk in patients undergoing post-operative catheter-based interventions, the predicted risk of an adverse event based on CRISP scores was compared to actual adverse event rates. A single-center, retrospective review of patients undergoing catheterization interventions within 6 weeks of cardiac surgery was conducted between Jan 2004 and Dec 2014. Patients who underwent dilation interventions across fresh suture lines (group 1) were compared to patients who underwent interventional procedures at other sites (group 2), and a CRISP score was calculated for all patients. Patients receiving only surveillance biopsies were excluded. Sixty-eight patients underwent 100 interventional procedures. Group 1 was composed of 44 patients receiving 64 interventions, while group 2 had 24 patients who underwent 36 interventions. Group 1 was comprised significantly more single ventricles and patients were smaller/younger. Group 1 had a significantly higher median CRISP score, but both groups were within Category 4. The rates of adverse events were similar between groups and comparable to predicted rates with the CRISP scoring system. Catheter-based interventions in the early post-operative period can be performed with no significant increase in the risk of serious adverse events when intervening across fresh suture lines. The CRISP scoring system can be a valuable tool in pre-procedural counseling of high-risk post-operative patients.
由于担心手术风险增加，尤其是在新鲜缝合线部位，术后早期基于导管的干预操作需谨慎进行。最近发布的CRISP评分系统基于术前标准提供前瞻性风险分层。为了优化对接受术后基于导管干预的患者的风险评估，将基于CRISP评分预测的不良事件风险与实际不良事件发生率进行了比较。对2004年1月至2014年12月期间在心脏手术后6周内接受导管介入治疗的患者进行了单中心回顾性研究。将在新鲜缝合线部位进行扩张干预的患者（第1组）与在其他部位进行介入操作的患者（第2组）进行比较，并为所有患者计算CRISP评分。仅接受监测活检的患者被排除。68例患者接受了100次介入手术。第1组由44例接受64次干预的患者组成，而第2组有24例接受36次干预的患者。第1组单心室患者明显更多，且患者体型更小/年龄更小。第1组的CRISP评分中位数显著更高，但两组均处于4类。两组不良事件发生率相似，且与CRISP评分系统预测的发生率相当。在新鲜缝合线部位进行干预时，术后早期基于导管的干预操作不会显著增加严重不良事件的风险。CRISP评分系统在高危术后患者的术前咨询中可能是一个有价值的工具。
