Dolgner Stephen J, Krieger Eric V, Wilkes Jacob, Bratton Susan L, Thiagarajan Ravi R, Barrett Cindy S, Chan Titus
Division of Cardiology, Seattle Children's Hospital, Seattle, Washington.
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Congenit Heart Dis. 2019 Jul;14(4):559-570. doi: 10.1111/chd.12758. Epub 2019 Mar 5.
Adult congenital heart disease (ACHD) patients who undergo cardiac surgery are at risk for poor outcomes, including extracorporeal membrane oxygenation support (ECMO) and death. Prior studies have demonstrated risk factors for mortality, but have not fully examined risk factors for ECMO or death without ECMO (DWE). We sought to identify risk factors for ECMO and DWE in adults undergoing congenital heart surgery in tertiary care children's hospitals.
All adults (≥18 years) undergoing congenital heart surgery in the Pediatric Health Information System (PHIS) database between 2003 and 2014 were included. Patients were classified into three groups: ECMO-free survival, requiring ECMO, and DWE. Univariate analyses were performed, and multinomial logistic regression models were constructed examining ECMO and DWE as independent outcomes.
Tertiary care children's hospitals.
A total of 4665 adult patients underwent ACHD surgery in 39 children's hospitals with 51 (1.1%) patients requiring ECMO and 64 (1.4%) patients experiencing DWE. Of the 51 ECMO patients, 34 (67%) died. Increasing patient age, surgical complexity, diagnosis of single ventricle heart disease, preoperative hospitalization, and the presence of noncardiac complex chronic conditions (CCC) were risk factors for both outcomes. Additionally, low and medium hospital ACHD surgical volume was associated with an increased risk of DWE in comparison with ECMO.
There are overlapping but separate risk factors for ECMO support and DWE among adults undergoing congenital heart surgery in pediatric hospitals.
接受心脏手术的成人先天性心脏病（ACHD）患者面临不良结局的风险，包括体外膜肺氧合支持（ECMO）和死亡。既往研究已证实了死亡的危险因素，但尚未全面研究ECMO或无ECMO死亡（DWE）的危险因素。我们试图确定在三级儿童医院接受先天性心脏手术的成人患者中ECMO和DWE的危险因素。
纳入2003年至2014年期间在儿科健康信息系统（PHIS）数据库中接受先天性心脏手术的所有成人（≥18岁）患者。患者分为三组：无ECMO存活、需要ECMO以及DWE。进行单因素分析，并构建多项逻辑回归模型，将ECMO和DWE作为独立结局进行研究。
三级儿童医院。
共有4665例成年患者在39家儿童医院接受了ACHD手术，其中51例（1.1%）患者需要ECMO，64例（1.4%）患者发生DWE。在51例接受ECMO治疗的患者中，34例（67%）死亡。患者年龄增加、手术复杂性、单心室心脏病诊断、术前住院以及存在非心脏复杂慢性疾病（CCC）是这两种结局的危险因素。此外，与ECMO相比，低和中等医院的ACHD手术量与DWE风险增加相关。
在儿科医院接受先天性心脏手术的成人中，ECMO支持和DWE存在重叠但又各自独立的危险因素。
