Inohara Taku, Ichihara Nao, Kohsaka Shun, Miyata Hiroaki, Hirata Yasutaka, Murakami Arata, Shimizu Hideyuki, Aeba Ryo
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Japan Cardiovascular Surgical Database, Kanazawa, Japan.
Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan; Japan Cardiovascular Surgical Database, Kanazawa, Japan.
J Thorac Cardiovasc Surg. 2019 Mar;157(3):1132-1141.e7. doi: 10.1016/j.jtcvs.2018.11.111. Epub 2018 Dec 12.
In infants with ventricular septal defect (VSD) who undergo surgical intervention, body weight, along with age, is frequently thought to be the decisive predictor of morbidity and mortality after surgery; however, its information on quantitative risk assessment is limited.
All infants (<1 year old) with a fundamental diagnosis of VSD who underwent surgical VSD closure or pulmonary artery banding between 2012 and 2016 were identified from the Japan Cardiovascular Surgery Database Congenital Section. The outcome of interest was a composite end point of all-cause death and major complications within 30 days after surgery. We evaluated the association between body weight at surgery and composite end point using logistic regression models.
A total of 4947 cases were analyzed (median age, 125; interquartile range [IQR], 79-193 days; median body weight, 4.94 [IQR, 4.00-6.00] kg), including 4310 cases (87.1%) treated with surgical VSD closure and 637 (12.9%) treated with pulmonary artery banding. The surgical course was uncomplicated in 94.2% of cases, 23 (0.5%) died, and 283 (5.7%) experienced major complications. The risk of the composite end point was higher along with lower body weight (adjusted odds ratio, 1.56 for every -1 kg; 95% confidence interval, 1.30-1.88; P < .001) and plateaued at body weight of approximately >4.5 kg via smoothing spline curve. Importantly, cases with approximately <4.5 kg of body weight had higher predicted risk regardless of age.
Surgical intervention for infants with VSD was safely performed in contemporary practice; however, caution is warranted in lower body weight infants, particularly for infants with approximately <4.5 kg.
在接受手术干预的室间隔缺损（VSD）婴儿中，体重与年龄常被认为是术后发病和死亡的决定性预测因素；然而，其在定量风险评估方面的信息有限。
从日本心血管外科数据库先天性疾病部分中识别出2012年至2016年间接受VSD手术闭合或肺动脉环扎术的所有基本诊断为VSD的婴儿（<1岁）。感兴趣的结局是术后30天内全因死亡和主要并发症的复合终点。我们使用逻辑回归模型评估手术时体重与复合终点之间的关联。
共分析了4947例病例（中位年龄125天；四分位间距[IQR]，79 - 193天；中位体重4.94[IQR，4.00 - 6.00]kg），其中4310例（87.1%）接受了VSD手术闭合治疗，637例（12.9%）接受了肺动脉环扎术治疗。94.2%的病例手术过程无并发症，23例（0.5%）死亡，283例（5.7%）发生主要并发症。复合终点的风险随着体重降低而升高（调整后的优势比，每降低1kg为1.56；95%置信区间，1.30 - 1.88；P <.001），通过平滑样条曲线可知，体重约>4.5kg时趋于平稳。重要的是，体重约<4.5kg的病例无论年龄大小，预测风险都较高。
在当代实践中，对VSD婴儿进行手术干预是安全的；然而，对于体重较低的婴儿，尤其是体重约<4.5kg的婴儿，需要谨慎对待。
