Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois.
Ann Thorac Surg. 2022 Nov;114(5):1771-1777. doi: 10.1016/j.athoracsur.2022.03.011. Epub 2022 Mar 25.
We sought to characterize short- and long-term outcomes after superior cavopulmonary connection (SCPC) in children eligible for inclusion of antegrade pulmonary blood flow (APBF) in the SCPC circuit, exploring whether maintaining APBF was associated with outcomes.
This was a retrospective cohort study of patients with single-ventricle heart disease and APBF who underwent SCPC at our center between January 1, 2000, and September 30, 2017. Patients were divided into 2 groups: APBF eliminated (APBF-), and APBF maintained (APBF+) at the time of SCPC.
Of 149 patients, 108 (72.5%) were in APBF- and 41 (27.5%) were in APBF+. Of those in APBF+, 5 (12.2%) subsequently had APBF eliminated after SCPC. Patients in APBF+ had a higher prevalence of chest tube duration >10 days and underwent more interventions during the post-SCPC hospitalization (1.9% vs 12%; P = .008 for both) but had shorter surgical support times at SCPC (P < .0001). There were no differences in post-SCPC intensive care unit or hospital length of stay. During the study period, 82 patients (76%) in APBF- and 22 patients (54%) in APBF+ underwent Fontan completion. Patients in APBF+ had a greater weight gain from SCPC to Fontan (6.7 [1.8-22] kg vs 8.15 [4.4-20.6] kg; P = .012) and a shorter hospital length of stay after Fontan (9 [4-107] days vs 7.5 [4-14] days; P = .044).
Short-term morbidity associated with maintaining APBF at the time of SCPC is modest, but longer term outcomes suggest potential benefits in those in whom APBF can be successfully maintained.
我们旨在描述符合纳入上腔静脉-肺动脉连接（SCPC）回路前向肺血流（APBF）条件的患儿行 SCPC 后的短期和长期结局，并探讨维持 APBF 是否与结局相关。
这是一项回顾性队列研究，纳入了 2000 年 1 月 1 日至 2017 年 9 月 30 日期间在我院行 SCPC 的单心室心脏病合并 APBF 患儿。患儿分为两组：SCPC 时消除 APBF（APBF-）和维持 APBF（APBF+）。
149 例患儿中，108 例（72.5%）为 APBF-，41 例（27.5%）为 APBF+。APBF+中有 5 例（12.2%）患儿在 SCPC 后 APBF 消除。APBF+患儿的胸腔引流管时间>10 天和 SCPC 后住院期间接受更多干预的比例较高（1.9% vs. 12%；均 P =.008），但 SCPC 手术支持时间较短（P <.0001）。两组患儿 SCPC 后的 ICU 或住院时间无差异。研究期间，APBF-中有 82 例（76%）和 APBF+中有 22 例（54%）患儿行 Fontan 完成术。APBF+患儿从 SCPC 到 Fontan 的体重增长更大（6.7 [1.8-22]kg vs. 8.15 [4.4-20.6]kg；P =.012），Fontan 术后住院时间更短（9 [4-107]d vs. 7.5 [4-14]d；P =.044）。
SCPC 时维持 APBF 相关的短期发病率适中，但长期结局表明对于那些能够成功维持 APBF 的患儿可能具有潜在获益。
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