Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil.
Faculdade de Tecnologia e ciências, Salvador, BA - Brazil.
Arq Bras Cardiol. 2019 Sep 9;113(4):748-756. doi: 10.5935/abc.20190184. eCollection 2019.
Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results.
To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease.
Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant.
Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes.
The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.
在患有慢性风湿性心脏病的儿科患者中，二尖瓣修复优于瓣膜置换，并且已经取得了良好的效果。
确定风湿性心脏病儿童和青少年接受二尖瓣成形术的不良结局的预测因素。
回顾性研究 2011 年 3 月至 2017 年 1 月期间在一家三级儿科医院接受手术的 54 名 16 岁以下的患者。不良结局风险的预测因素为：年龄、射血分数、二尖瓣关闭不全程度、肺动脉高压程度、三尖瓣关闭不全、左心室扩张、术前功能分类、体外循环持续时间、缺氧持续时间、心房颤动、血管活性药物使用时间。评估的结果为：死亡、充血性心力衰竭、再次手术、残余二尖瓣反流、残余二尖瓣狭窄、中风、出血和瓣膜置换。所有分析均设定 p 值<0.05 为有统计学意义。
评估的患者中，29 例（53.7%）为女性，平均年龄 10.5±3.2 岁。13 例（25%）的功能分类为 4 级。研究样本中无死亡病例。体外循环平均持续时间为 62.7±17.8 分钟，缺氧持续时间为 50±15.7 分钟。血管活性药物在术后即刻的使用时间平均为 1 天（四分位间距 1-2 天）。使用逻辑回归模型评估每个不良结局的预测变量。血管活性药物的使用时间是唯一与研究结果相关的独立预测因素（p=0.007）。残余二尖瓣关闭不全与再次手术相关（p=0.044），而三尖瓣关闭不全（p=0.012）和肺动脉高压（p=0.012）与不良结局相关。
血管活性药物使用时间是术后即刻和晚期不良结局的独立预测因素，而残余二尖瓣反流与再次手术相关，三尖瓣反流和肺动脉高压均与不良结局相关。
