Pizzuto Matthew, Patel Mehul, Romano Jennifer, Retzloff Lauren, Yu Sunkyung, Lowery Ray, Gelehrter Sarah
1 C.S. Mott Hospital, University of Michigan, Ann Arbor, MI, USA.
2 Duke Children's Hospital, Duke University, Durham, NC, USA.
World J Pediatr Congenit Heart Surg. 2018 Jul;9(4):407-411. doi: 10.1177/2150135118768720.
Interstage outcomes for single ventricle infants following Norwood operation have been well studied, showing significant mortality. Other single ventricle infants require only an aortopulmonary shunt. The aim of the study was to describe the interstage outcomes of this group compared to Norwood patients and identify risk factors for mortality.
A single-center retrospective cohort review was performed in patients who underwent a Norwood operation (Norwood) or aortopulmonary shunt (Shunt) during 2000 to 2011 and survived to discharge. Hybrid or pulmonary artery banding patients were excluded. Univariate comparison was made between Norwood and Shunt patients as well as a Shunt subgroup analysis.
A total of 486 patients (368 Norwood and 118 Shunt) were included. Norwood and Shunt patients were similar in terms of preterm birth, surgery weight, and stage 1 complications. Shunt patients were more likely to be female, have an extracardiac or genetic anomaly, and have a shorter hospital length of stay compared to the Norwood patients (all P < .0001). No significant difference in interstage mortality was seen between the Shunt and Norwood patients (6.8% vs 11.1%, respectively; P = .17). Stage 2 mortality was also similar (Shunt 4.6% vs Norwood 7.8%; P = .25). In the Shunt patients, those who died during interstage weighed less at surgery (2.7 [0.7] kg vs 3.3 [0.7] kg, P = .03) and were more likely to have arrhythmias (50% vs 12%, P = .01), compared to survivors.
Shunt patients have an interstage mortality that is not significantly less than Norwood patients. Lower weight at surgery and arrhythmias are risk factors for interstage death in Shunt patients.
单心室婴儿在诺伍德手术后的过渡期结局已得到充分研究，显示出显著的死亡率。其他单心室婴儿仅需要体肺分流术。本研究的目的是描述该组患者与诺伍德手术患者相比的过渡期结局，并确定死亡的危险因素。
对2000年至2011年期间接受诺伍德手术（诺伍德组）或体肺分流术（分流组）并存活至出院的患者进行单中心回顾性队列研究。排除接受杂交手术或肺动脉环扎术的患者。对诺伍德组和分流组患者进行单因素比较，并对分流组进行亚组分析。
共纳入486例患者（368例诺伍德组和118例分流组）。诺伍德组和分流组患者在早产、手术体重和一期并发症方面相似。与诺伍德组患者相比，分流组患者更可能为女性，有心脏外或遗传异常，住院时间更短（均P <.0001）。分流组和诺伍德组患者的过渡期死亡率无显著差异（分别为6.8%和11.1%；P =.17）。二期死亡率也相似（分流组4.6% vs诺伍德组7.8%；P =.25）。在分流组患者中，与幸存者相比，过渡期死亡的患者手术时体重更轻（2.7 [0.7] kg vs 3.3 [0.7] kg，P =.03），且更可能发生心律失常（50% vs 12%，P =.01）。
分流组患者的过渡期死亡率并不显著低于诺伍德组患者。手术时体重较低和心律失常是分流组患者过渡期死亡的危险因素。
