Guariento Alvise, Doulamis Ilias P, Staffa Steven J, Gellis Laura, Oh Nicholas A, Kido Takashi, Mayer John E, Baird Christopher W, Emani Sitaram M, Zurakowski David, Del Nido Pedro J, Nathan Meena
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2022 Jan;163(1):224-236.e6. doi: 10.1016/j.jtcvs.2021.01.136. Epub 2021 Feb 12.
In this study, we sought to identify independent risk factors for mortality and reintervention after early surgical correction of truncus arteriosus using a novel statistical method.
Patients undergoing neonatal/infant truncus arteriosus repair between January 1984 and December 2018 were reviewed retrospectively. An innovative statistical strategy was applied integrating competing risks analysis with modulated renewal for time-to-event modeling.
A total of 204 patients were included in the study. Mortality occurred in 32 patients (15%). Smaller right ventricle to pulmonary artery conduit size and truncal valve insufficiency at birth were significantly associated with overall mortality (right ventricle to pulmonary artery conduit size: hazard ratio, 1.34; 95% confidence interval, 1.08-1.66, P = .008; truncal valve insufficiency: hazard ratio, 2.5; 95% confidence interval, 1.13-5.53, P = .024). truncal valve insufficiency at birth, truncal valve intervention at index repair, and number of cusps (4 vs 3) were associated with truncal valve reoperations (truncal valve insufficiency: hazard ratio, 2.38; 95%, confidence interval, 1.13-5.01, P = .02; cusp number: hazard ratio, 6.62; 95% confidence interval, 2.54-17.3, P < .001). Right ventricle to pulmonary artery conduit size 11 mm or less was associated with a higher risk of early catheter-based reintervention (hazard ratio, 1.54; 95% confidence interval, 1.04-2.28, P = .03) and reoperation (hazard ratio, 1.96; 95% confidence interval, 1.33-2.89, P = .001) on the right ventricle to pulmonary artery conduit.
Smaller right ventricle to pulmonary artery conduit size and truncal valve insufficiency at birth were associated with overall mortality after truncus arteriosus repair. Quadricuspid truncal valve, the presence of truncal valve insufficiency at the time of diagnosis, and truncal valve intervention at index repair were associated with an increased risk of reoperation. The size of the right ventricle to pulmonary artery conduit at index surgery is the single most important factor for early reoperation and catheter-based reintervention on the conduit.
在本研究中，我们试图使用一种新颖的统计方法来确定动脉干早期手术矫正后死亡和再次干预的独立危险因素。
回顾性分析1984年1月至2018年12月期间接受新生儿/婴儿动脉干修复手术的患者。应用了一种创新的统计策略，将竞争风险分析与事件发生时间建模的调制更新相结合。
本研究共纳入204例患者。32例患者死亡（15%）。右心室至肺动脉导管尺寸较小和出生时动脉干瓣膜关闭不全与总体死亡率显著相关（右心室至肺动脉导管尺寸：风险比，1.34；95%置信区间，1.08 - 1.66，P = .008；动脉干瓣膜关闭不全：风险比，2.5；95%置信区间，1.13 - 5.53，P = .024）。出生时动脉干瓣膜关闭不全、初次修复时动脉干瓣膜干预以及瓣叶数量（4个对3个）与动脉干瓣膜再次手术相关（动脉干瓣膜关闭不全：风险比，2.38；95%置信区间，1.13 - 5.01，P = .02；瓣叶数量：风险比，6.62；95%置信区间，2.54 - 17.3，P < .001）。右心室至肺动脉导管尺寸小于或等于11 mm与基于导管的早期再次干预风险较高相关（风险比，1.54；95%置信区间，1.04 - 2.28，P = .03）以及对右心室至肺动脉导管进行再次手术（风险比，1.96；95%置信区间，1.33 - 2.89，P = .001）。
右心室至肺动脉导管尺寸较小和出生时动脉干瓣膜关闭不全与动脉干修复后的总体死亡率相关。四叶式动脉干瓣膜、诊断时存在动脉干瓣膜关闭不全以及初次修复时动脉干瓣膜干预与再次手术风险增加相关。初次手术时右心室至肺动脉导管的尺寸是导管早期再次手术和基于导管的再次干预的最重要单一因素。
