连续室间隔破裂手术的围手术期风险评估：寻求一种新的综合方法。

Perioperative Risk Assessment for Surgery of Consecutive Cases with Ventricular Septal Rupture: Seeking A Novel and Comprehensive Method.

机构信息

Department of Anesthesiology, Peking University People's Hospital, Beijing, China.

Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China.

出版信息

Heart Surg Forum. 2021 May 24;24(3):E461-E466. doi: 10.1532/hsf.3753.

DOI:10.1532/hsf.3753

PMID:34173753

Abstract

BACKGROUND

Ventricular septal rupture (VSR) is a rare but lethal complication occurring after acute myocardial infarction. The aim of our study was to review the single-center experience of surgery for VSR and seek a comprehensive evaluation process for early mortality.

METHODS

Patients undergoing surgical repair for postinfarction VSR in our institution retrospectively were evaluated from Jan. 2006 to Dec. 2019. The endpoint of the study was mortality within 30 days after VSR surgery, which was divided into survivors and nonsurvivors. The calibration and discrimination of two risk evaluation systems (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) risk score) in total were compared by Hosmer-Lemeshow, and the area under the receiver operating characteristic curve (AUC). Risk factors in subsets were assessed by logistic regression analysis.

RESULTS

Twenty-three patients undergoing surgery for VSR repair were reviewed, and the early mortality after surgery was 34.8% (N = 8). The expected mortality predicted by EuroSCORE II was 24.3%, and that of the STS score was 12.2%. Both the EuroSCORE II and STS risk evaluation systems showed positive calibration in predicting mortality (H-L: P = 0.117 and P = 0.346, respectively) but poor discriminative power (AUC=0.633 and 0.575). Significant predictors determined by univariate analysis were concomitant coronary artery bypass grafting (CABG) (P = 0.035) and postoperative continuous renal replacement therapy (CRRT) (P = 0.008).

CONCLUSION

Early mortality of VSR after surgery remains high, and the evaluation process is complicated. The performances of the two risk evaluation systems were not optimal, but EuroSCORE II was more accurate than STS. Patients with lower preoperation EuroSCORE II, concomitant CABG during repair, and no need for CRRT after surgery may have a better early survival rate.

摘要

背景

室间隔破裂（VSR）是急性心肌梗死后罕见但致命的并发症。本研究的目的是回顾单中心 VSR 手术经验，并寻求全面的早期死亡率评估过程。

方法

回顾性分析 2006 年 1 月至 2019 年 12 月在我院行手术修复的心肌梗死后 VSR 患者。本研究的终点为 VSR 手术后 30 天内的死亡率，分为幸存者和非幸存者。通过 Hosmer-Lemeshow 比较两种风险评估系统（欧洲心脏手术风险评估系统 II（EuroSCORE II）和胸外科医师学会（STS）风险评分）的校准和判别能力，并通过受试者工作特征曲线下面积（AUC）进行评估。通过 logistic 回归分析评估亚组中的危险因素。

结果

共回顾 23 例行 VSR 修复手术的患者，术后早期死亡率为 34.8%（N=8）。EuroSCORE II 预测的预期死亡率为 24.3%，STS 评分的预测死亡率为 12.2%。EuroSCORE II 和 STS 风险评估系统在预测死亡率方面均显示出正校准（H-L：P=0.117 和 P=0.346），但判别能力较差（AUC=0.633 和 0.575）。单因素分析确定的显著预测因素为同期冠状动脉旁路移植术（CABG）（P=0.035）和术后持续肾脏替代治疗（CRRT）（P=0.008）。