Division of Pediatric Cardiology, Department of Pediatrics, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
Division of Pediatric Cardiology, Department of Pediatrics, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2019 Nov;108(5):1423-1429. doi: 10.1016/j.athoracsur.2019.06.041. Epub 2019 Aug 7.
Anatomic lesions are a common cause of decompensation during the interstage period after Norwood stage 1 palliation (S1P). This study describes the risk factors for and outcomes after unplanned surgical and catheter-based interstage cardiac interventions.
Participants in the National Pediatric Cardiology Quality Improvement Collaborative registry discharged from the hospital after S1P between 2008 and 2016 were studied. Variables at S1P, interstage, and at stage 2 palliation (S2P) hospitalizations were examined. Multivariable logistic regression was used to compare those who had an unplanned interstage intervention to those who did not.
Of 1994 participants from 60 programs, 343 (17.1%) had at least 1 unplanned interstage intervention. Aortic valve dilation before S1P, longer S1P cardiopulmonary bypass time, pulmonary artery stent placement between S1P and discharge, aortic arch obstruction on the S1P discharge echocardiogram, and lower weight at S1P discharge were independently associated with receiving an unplanned interstage intervention. Interstage mortality between groups was similar at 6%, as was interstage duration. Participants undergoing unplanned interstage interventions were more likely to undergo heart transplant before S2P or deemed to be unsuitable for S2P (7.3% vs 2.7%, P < .001).
Unplanned interstage interventions after S1P did not increase interstage mortality, but participants with an unplanned intervention were less likely to progress to S2P. Residual anatomic lesions are risk factors for unplanned interstage interventions. For those with progressive ventricular dysfunction in the presence of arch obstruction by echocardiogram, aortic arch reintervention is warranted.
解剖学病变是 Norwood 一期姑息术后（S1P）中期失代偿的常见原因。本研究描述了计划外外科和导管介入性中期心脏干预的风险因素和结果。
研究对象为 2008 年至 2016 年期间在 S1P 后出院的国家儿科心脏病学质量改进合作登记处参与者。研究了 S1P、中期和 S2P 姑息治疗（S2P）住院时的变量。使用多变量逻辑回归比较了计划外中期干预组和非计划外中期干预组。
在来自 60 个项目的 1994 名参与者中，有 343 名（17.1%）至少有 1 次计划外中期干预。S1P 前主动脉瓣扩张、S1P 体外循环时间较长、S1P 与出院期间肺动脉支架放置、S1P 出院超声心动图上主动脉弓梗阻以及 S1P 出院时体重较低与接受计划外中期干预独立相关。两组之间的中期死亡率相似（6%），中期持续时间也相似。接受计划外中期干预的参与者在 S2P 前更有可能接受心脏移植或被认为不适合 S2P（7.3%比 2.7%，P<.001）。
S1P 后计划外中期干预并未增加中期死亡率，但接受计划外干预的参与者更不可能进展到 S2P。残留的解剖学病变是计划外中期干预的危险因素。对于那些存在心室功能障碍且超声心动图显示弓部梗阻的患者，需要进行主动脉弓再干预。
