Burstein Danielle S, Gray Patrick E, Griffis Heather M, Glatz Andrew C, Cohen Meryl S, Gaynor J William, Goldberg David J
Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Cardiol. 2019 Jun;40(5):1057-1063. doi: 10.1007/s00246-019-02116-0. Epub 2019 May 7.
In complete atrioventricular canal defect (CAVC), there are limited data on preoperative clinical and echocardiographic predictors of operative timing and postoperative outcomes. A retrospective, single-center analysis of all patients who underwent primary biventricular repair of CAVC between 2006 and 2015 was performed. Associated cardiac anomalies (tetralogy of Fallot, double outlet right ventricle) and arch operation were excluded. Echocardiographic findings on first postnatal echocardiogram were correlated with surgical timing and postoperative outcomes using bivariate descriptive statistics and multivariable logistic regression. 153 subjects (40% male, 84% Down syndrome) underwent primary CAVC repair at a median age of 3.3 (IQR 2.5-4.2) months. Median postoperative length of stay (LOS) was 7 (IQR 5-15) days. Eight patients (5%) died postoperatively and 24 (16%) required reoperation within 1 year. On multivariable analysis, small aortic isthmus (z score < - 2) was associated with early primary repair at < 3 months (OR 2.75, 95% CI 1.283-5.91) and need for early reoperation (OR 3.79, 95% CI 1.27-11.34). Preoperative ventricular dysfunction was associated with higher postoperative mortality (OR 7.71, 95% CI 1.76-33.69). Other factors associated with mortality and longer postoperative LOS were prematurity (OR 5.30, 95% CI 1.24-22.47 and OR 5.50, 95% CI 2.07-14.59, respectively) and lower weight at surgery (OR 0.17, 95% CI 0.04-0.75 and OR 0.55, 95% CI 0.35-0.85, respectively). Notably, preoperative atrioventricular valve regurgitation and Down syndrome were not associated with surgical timing, postoperative outcomes or reoperation, and there were no echocardiographic characteristics associated with late reoperation beyond 1 year after repair. Key preoperative echocardiographic parameters helped predict operative timing and postoperative outcomes in infants undergoing primary CAVC repair. Aortic isthmus z score < - 2 was associated with early surgical repair and need for reoperation, while preoperative ventricular dysfunction was associated with increased mortality. These echocardiographic findings may help risk-stratified patients undergoing CAVC repair and improve preoperative counseling and surgical planning.
在完全性房室通道缺损（CAVC）中，关于手术时机和术后结局的术前临床及超声心动图预测因素的数据有限。我们对2006年至2015年间接受CAVC一期双心室修复的所有患者进行了一项回顾性单中心分析。排除了相关心脏畸形（法洛四联症、右心室双出口）及主动脉弓手术。使用双变量描述性统计和多变量逻辑回归分析，将出生后首次超声心动图检查结果与手术时机及术后结局进行关联分析。153名受试者（40%为男性，84%患有唐氏综合征）接受了CAVC一期修复，中位年龄为3.3（四分位间距2.5 - 4.2）个月。术后中位住院时间（LOS）为7（四分位间距5 - 15）天。8名患者（5%）术后死亡，24名患者（16%）在1年内需要再次手术。多变量分析显示，小主动脉峡部（z评分＜ -2）与3个月内早期一期修复相关（比值比2.75，95%置信区间1.283 - 5.91）以及早期再次手术需求相关（比值比3.79，95%置信区间1.27 - 11.34）。术前心室功能障碍与术后较高死亡率相关（比值比7.71，95%置信区间1.76 - 33.69）。与死亡率及术后住院时间延长相关的其他因素分别为早产（比值比5.30，95%置信区间1.24 - 22.47和比值比5.50，95%置信区间2.07 - 14.59）以及手术时体重较低（比值比0.17，95%置信区间0.04 - 0.75和比值比0.55，95%置信区间0.35 - 0.85）。值得注意的是，术前房室瓣反流及唐氏综合征与手术时机、术后结局或再次手术无关，且修复后1年以上的晚期再次手术无相关超声心动图特征。关键的术前超声心动图参数有助于预测接受CAVC一期修复婴儿的手术时机及术后结局。主动脉峡部z评分＜ -2与早期手术修复及再次手术需求相关，而术前心室功能障碍与死亡率增加相关。这些超声心动图检查结果可能有助于对接受CAVC修复的患者进行风险分层，并改善术前咨询及手术规划。
