Purifoy Eric T, Spray Beverly J, Riley Joe S, Prodhan Parthak, Bolin Elijah H
Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA.
Biostatistics Core, Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202-3591, USA.
Pediatr Cardiol. 2019 Dec;40(8):1627-1632. doi: 10.1007/s00246-019-02196-y. Epub 2019 Sep 7.
Trisomy 21 (T21) is the most common chromosomal abnormality, and is frequently associated with congenital heart disease. Results of previous studies evaluating the effect of T21 on postoperative outcomes and complications following heart surgery have been mixed. Our goal was to determine if T21 is associated with higher frequency of adverse postoperative outcomes following repair of tetralogy of Fallot (TOF). A query of the Pediatric Health Information System was performed for patients who underwent complete repair of TOF from 2004 to 2015. Patients with a genetic syndrome other than T21 and tracheostomy and/or gastrostomy prior to heart surgery were excluded. Two groups were created on the basis of whether patients received a diagnostic code for T21. The adverse outcomes of interest were postoperative mortality, postoperative length of stay (LOS), postoperative gastrostomy, and postoperative tracheostomy. Univariate and Kaplan-Meier analysis were performed to evaluate outcomes. There were a total of 4790 patients; 430 (9%) patients had T21, and 4360 (91%) patients without a genetic diagnosis. There was no significant difference in mortality before discharge between those with and without T21 (2.3% vs 1.4%; p = 0.155). Patients with T21 had longer postoperative LOS (mean of 19.8 days vs 12.4 days; p < 0.001), and higher rates of postoperative gastrostomy (13.3% vs 5.3%; p < 0.02). There was no significant difference between groups for rates of postoperative tracheostomy (1.9% vs 1.2%; p = 0.276). Kaplan-Meier analysis confirmed that patients with T21 had longer postoperative LOS and greater incidence of gastrostomy.
21三体综合征（T21）是最常见的染色体异常疾病，且常与先天性心脏病相关。既往评估T21对心脏手术后结局及并发症影响的研究结果不一。我们的目标是确定T21是否与法洛四联症（TOF）修复术后不良结局的更高发生率相关。对2004年至2015年期间接受TOF完全修复术的患者进行了儿科健康信息系统查询。排除患有除T21以外的遗传综合征以及在心脏手术前已行气管切开术和/或胃造口术的患者。根据患者是否有T21诊断编码分为两组。感兴趣的不良结局包括术后死亡率、术后住院时间（LOS）、术后胃造口术和术后气管切开术。采用单因素分析和Kaplan-Meier分析评估结局。共有4790例患者；430例（9%）患者患有T21，4360例（91%）患者无遗传诊断。有T21和无T21患者出院前死亡率无显著差异（2.3%对1.4%；p = 0.155）。患有T21的患者术后住院时间更长（平均19.8天对12.4天；p < 0.001），术后胃造口术发生率更高（13.3%对5.3%；p < 0.02）。两组术后气管切开术发生率无显著差异（1.9%对1.2%；p = 0.276）。Kaplan-Meier分析证实，患有T21的患者术后住院时间更长，胃造口术发生率更高。
