Przybylski Robert, Hedequist Daniel J, Nasr Viviane G, McCann Mary Ellen, Brustowicz Robert M, Emans John B, Marshall Audrey C, Brown David W
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA.
Pediatr Cardiol. 2019 Oct;40(7):1468-1475. doi: 10.1007/s00246-019-02169-1. Epub 2019 Jul 26.
Scoliosis is common in children with congenital heart disease (CHD) and may have deleterious effects on quality of life and hemodynamics. Relatively little is known about the outcomes of spinal fusion for scoliosis repair in children with complex CHD. We reviewed all cases of children with CHD undergoing first time spinal fusion excluding those with minor CHD between 1995 and 2015. Seventy-eight patients were identified and included in the study. 97.4% of patients included had undergone prior cardiac surgery and sixteen patients had single ventricle circulations. 17.9% of patients experienced a significant perioperative event defined as an aggregate of the presence of any of the following: need for early unanticipated reoperation, neurologic deficit, postoperative bleeding requiring intervention, end organ dysfunction, or death. There were no deaths in our cohort. 38.5% of patients experienced any adverse event, the majority of which were related to perioperative fluid shifts. Larger preoperative Cobb angle and longer length of spinal fusion were associated with increased risk of significant perioperative event while larger preoperative Cobb angle and longer length of spinal fusion, older age at time of surgery, single ventricle circulation, cyanosis and patients taking cardiac medications at the time of surgery were more likely to experience any adverse event. Operative repair of scoliosis in children with complex CHD has been performed without mortality over a 20-year period in a single institution, albeit with a higher rate of perioperative complication than is seen in the general pediatric population. Patients with large preoperative Cobb angles and cyanotic single ventricle circulations appear to be at the highest risk for perioperative complications.
脊柱侧弯在先天性心脏病（CHD）患儿中很常见，可能对生活质量和血流动力学产生有害影响。对于患有复杂CHD的儿童进行脊柱侧弯修复的脊柱融合术的结果，人们了解得相对较少。我们回顾了1995年至2015年间所有首次接受脊柱融合术的CHD患儿病例，但不包括患有轻度CHD的患儿。确定了78例患者并纳入研究。纳入的患者中有97.4%曾接受过心脏手术，16例患者为单心室循环。17.9%的患者经历了重大围手术期事件，定义为以下任何一种情况的总和：需要早期意外再次手术、神经功能缺损、需要干预的术后出血、终末器官功能障碍或死亡。我们的队列中没有死亡病例。38.5%的患者经历了任何不良事件，其中大多数与围手术期液体转移有关。术前Cobb角较大和脊柱融合长度较长与重大围手术期事件的风险增加相关，而术前Cobb角较大和脊柱融合长度较长、手术时年龄较大、单心室循环、发绀以及手术时服用心脏药物的患者更有可能经历任何不良事件。在单一机构中，20年来对患有复杂CHD的儿童进行脊柱侧弯手术修复均无死亡病例，尽管围手术期并发症发生率高于普通儿科人群。术前Cobb角较大且有发绀的单心室循环患者似乎围手术期并发症风险最高。
