Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
School of Public Health Management, Nanjing University of Chinese Medicine, Nanjing, China.
J Card Surg. 2021 Oct;36(10):3607-3618. doi: 10.1111/jocs.15893. Epub 2021 Aug 2.
Little is known regarding whether hyperoxic reoxygenation was associated with higher risk of cardiovascular disorder following tetralogy of Fallot repair.
We performed a nested case-control study among patients aged 1 month-18 years undergoing complete repair of tetralogy of Fallot in 2012-2018. We measured the highest perfusate oxygenation (PpO2) during aortic occlusion in 107 cardiovascular disorder cases and in 321 controls matched 1:3 to the cases on date of surgery, sex, and area of residence. We analyzed the association between PpO2 and outcome using multivariable conditional logistic regression adjusted for covariates. We further identified and integrated the risk covariates to build prediction nomograms.
Cases had higher percentage of exposure to PpO2 > 200 mmHg (86.0% vs. 76.1%, p = .019) than controls. Patients with PpO2 > 200 mmHg had an increased risk of cardiovascular disorder compared to those with PpO2 ≤ 200 mmHg (odd ratio [OR] = 2.075, 95% confidence interval [CI] = 1.035, 4.158, p = .039) adjusted for matching, clinical and procedural covariates. Categorical PpO2, lower body mass index, lower SpO2, untreated minor aortopulmonary collateral arteries, high immediately postoperative central venous pressure, and longer cardiopulmonary bypass time were independent risk factors for cardiovascular disorder (all p < .05). Combining PpO2 nomogram slightly improved discrimination compared with covariate-based nomogram alone for training cohort (area under receiver operating characteristic curve [AUC] = 0.768 vs. 0.761) and for internal validation (AUC = 0.759 vs. 0.753).
Our findings suggest association exists between high PpO2 during aortic occlusion and cardiovascular disorder risk, and nomogram integrating clinical and procedural factors may be useful in management of patients with tetralogy of Fallot.
关于法洛四联症修复后高氧再复氧是否与心血管疾病风险增加相关，目前知之甚少。
我们对 2012 年至 2018 年间接受完全法洛四联症修复的 1 个月至 18 岁患者进行了一项嵌套病例对照研究。我们测量了 107 例心血管疾病病例和 321 例对照在主动脉阻断期间最高灌注氧分压（PpO2），病例按手术日期、性别和居住地与对照组 1:3 匹配。我们使用多变量条件逻辑回归分析调整协变量后，分析了 PpO2 与结局之间的关系。我们进一步确定并整合风险协变量以构建预测列线图。
与对照组相比，病例组有更高比例的 PpO2＞200mmHg 暴露（86.0% vs. 76.1%，p=0.019）。与 PpO2≤200mmHg 相比，PpO2＞200mmHg 的患者心血管疾病的风险增加（比值比[OR]2.075，95%置信区间[CI]1.035，4.158，p=0.039），调整了匹配、临床和手术过程中的协变量。分类 PpO2、较低的体重指数、较低的 SpO2、未经治疗的小主动脉肺侧支血管、术后即刻较高的中心静脉压和较长的体外循环时间是心血管疾病的独立危险因素（均 p＜0.05）。与仅基于协变量的列线图相比，PpO2 列线图在训练队列中的区分度略有提高（接受者操作特征曲线下面积[AUC]0.768 vs. 0.761）和内部验证（AUC 0.759 vs. 0.753）。
我们的研究结果表明，主动脉阻断期间的高 PpO2 与心血管疾病风险之间存在关联，整合临床和手术因素的列线图可能有助于法洛四联症患者的管理。
