Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Crit Care Med. 2020 Sep;21(9):e782-e788. doi: 10.1097/PCC.0000000000002387.
It is believed that management of neonates with dextro-transposition of the great arteries is constantly improving. Renal function may play a role in the prognosis of patients after congenital heart surgery. The aim of this study was to describe the outcome of neonates who underwent arterial switch operation during the past 2 decades using renal function as a surrogate marker for morbidity and mortality.
Retrospective cohort study.
Dedicated cardiac ICU of a university-affiliated pediatric medical center.
Infants who underwent arterial switch surgery in 1993-2015.
None.
The cohort included 336 infants who underwent arterial switch operation for dextro-transposition of the great arteries (n = 169, 50%), transposition of the great arteries/ventricular septal defect (n = 133, 40%), or Taussig-Bing anomaly (n = 34, 10%). Between 1993-1998 and 2012-2015, the mean minimal postoperative estimated glomerular filtration rate rose from 30 mL/min/1.73 m to 40 mL/min/1.73 m (p < 0.05), and the proportion of patients with estimated glomerular filtration rate less than 30 mL/min/1.73 m decreased from 56% to 23% (p < 0.05). The daily furosemide dosage decreased from 4 mg/kg/d to 0.5 mg/kg/d (p < 0.05). Urinary output on operative day 0 decreased over time, but urinary output on operative day 2 significantly increased. Maximal lactate levels and time to lactate normalization decreased steadily. Dialysis was performed in only a few patients in the early periods, and in none in the last 6 years. The mean mortality rate of patients with dextro-transposition of the great arteries and transposition of the great arteries/ventricular septal defect decreased to 2.7% in the last 6 years. The odds ratio of a prolonged hospital stay (≥ 28 d) in a patient with estimated glomerular filtration rate less than 30 mL/min/1.73 m was 18.79, and in a patient with transposition of the great arteries/ventricular septal defect, 3.39. The odds ratio of dying after Rashkind atrial septostomy was 4.42.
During the past 2 decades, there has been significant improvement in outcome of patients undergoing transposition of the great arteries repair. Renal function was found to be a good prognostic marker of morbidity and mortality.
人们认为，患有大动脉右旋转位的新生儿的治疗效果正在不断改善。肾功能可能是先天性心脏病手术后患者预后的一个决定因素。本研究的目的是描述过去 20 年中接受大动脉调转术的新生儿的结局，将肾功能作为发病率和死亡率的替代标志物。
回顾性队列研究。
大学附属儿科医疗中心的专门心脏重症监护病房。
1993 年至 2015 年接受大动脉调转术的婴儿。
无。
该队列包括 336 名接受大动脉调转术治疗右旋大动脉转位（n = 169，50%）、大动脉转位/室间隔缺损（n = 133，40%）或 Taussig-Bing 畸形（n = 34，10%）的婴儿。1993 年至 1998 年和 2012 年至 2015 年期间，术后最小估计肾小球滤过率从 30ml/min/1.73m 升高到 40ml/min/1.73m（p<0.05），估计肾小球滤过率<30ml/min/1.73m 的患者比例从 56%降至 23%（p<0.05）。呋塞米的日剂量从 4mg/kg/d 降至 0.5mg/kg/d（p<0.05）。手术当天 0 点的尿量随时间减少，但手术当天 2 点的尿量明显增加。最大乳酸水平和乳酸正常化时间稳定下降。仅在早期的少数患者中进行了透析，而在过去 6 年中没有进行透析。大动脉右旋转位和大动脉转位/室间隔缺损患者的死亡率降至过去 6 年的 2.7%。估计肾小球滤过率<30ml/min/1.73m 的患者住院时间延长（≥28d）的优势比为 18.79，大动脉转位/室间隔缺损患者的优势比为 3.39。Rashkind 房间隔造口术后死亡的优势比为 4.42。
在过去的 20 年中，大动脉转位修复患者的治疗效果有了显著改善。肾功能是发病率和死亡率的良好预后标志物。
