Giordano Mario, Santoro Giuseppe, Agnoletti Gabriella, Carminati Mario, Donti Andrea, Guccione Paolo, Marasini Maurizio, Milanesi Ornella, Russo Maria Giovanna, Castaldi Biagio, Cheli Martino, Formigari Roberto, Gaio Gianpiero, Giugno Luca, Lunardini Alessia, Pepino Carlotta, Spadoni Isabella
Pediatric Cardiology, "Ospedali dei Colli", University of Campania "Luigi Vanvitelli", Naples, Italy.
Pediatric Cardiology, "Ospedali dei Colli", University of Campania "Luigi Vanvitelli", Naples, Italy; Pediatric Cardiology and GUCH Unit, "Ospedale del Cuore", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy.
Int J Cardiol. 2020 Sep 1;314:36-42. doi: 10.1016/j.ijcard.2020.04.013. Epub 2020 Apr 5.
Despite recent technical advances, interventional cardiac catheterization is still challenging in neonatal age and no specific data concerning early outcome are so far published in literature.
Neonatal trans-catheter cardiac interventions performed in high-volume Italian referral centers were retrospectively analyzed. Primary outcomes were procedural major adverse events, in-hospital mortality and procedural failure. Secondary outcomes were minor adverse events and need for blood transfusion.
From January 2000 to December 2017, 1423 newborns (mean weight 3.0 ± 0.6 kg, range 1.0-5.8; median age 2.0 days) underwent interventional cardiac catheterization. Overall, global procedure adverse event rate and in-hospital mortality were 10.2% and 5.2%, respectively. At multi-variable analysis, primary composite outcome was significantly related to low-weight (<2.5 kg) (p < 0.01) and younger age (≤7 days) (p < 0.01) at the procedure, prematurity (p < 0.01), uni-ventricular physiology (p < 0.01), associated genetic syndromes (p < 0.01) and procedure risk category (p < 0.01). No relationship between volume of activity of any single center and procedure outcome was found. Over time, a trend toward an increased number of procedures and their complexity was recorded. Trans-catheter management of cardiac malformations with critical, duct-dependent pulmonary blood flow by arterial duct stenting or right ventricular outflow tract stenting showed the highest increase.
Interventional cardiac catheterization is relatively safe and feasible in neonatal age. Peri-natal age, low weight, uni-ventricular physiology and genetic syndromes still significantly contribute to procedural morbidity and in-hospital mortality of this approach.
尽管近年来技术有所进步，但新生儿心脏介入导管术仍然具有挑战性，目前尚无关于早期结果的具体数据发表在文献中。
对意大利大型转诊中心进行的新生儿经导管心脏介入治疗进行回顾性分析。主要结局为手术主要不良事件、住院死亡率和手术失败。次要结局为轻微不良事件和输血需求。
2000年1月至2017年12月，1423例新生儿（平均体重3.0±0.6kg，范围1.0 - 5.8kg；中位年龄2.0天）接受了心脏介入导管术。总体而言，手术不良事件总发生率和住院死亡率分别为10.2%和5.2%。多变量分析显示，主要复合结局与手术时低体重（<2.5kg）（p<0.01）、年龄较小（≤7天）（p<0.01）、早产（p<0.01）、单心室生理状态（p<0.01）、相关遗传综合征（p<0.01）和手术风险类别（p<0.01）显著相关。未发现任何单个中心的手术量与手术结局之间存在关联。随着时间的推移，记录到手术数量及其复杂性呈增加趋势。通过动脉导管支架置入术或右心室流出道支架置入术对具有严重的、依赖动脉导管的肺血流的心脏畸形进行经导管管理的手术增加最多。
新生儿心脏介入导管术相对安全可行。围产期年龄、低体重、单心室生理状态和遗传综合征仍然是该方法手术发病率和住院死亡率的重要影响因素。
