Backes Emily R, Afonso Natasha S, Guffey Danielle, Tweddell James S, Tabbutt Sarah, Rudd Nancy A, O'Harrow Ginny, Molossi Silvana, Hoffman George M, Hill Garick, Heinle Jeffrey S, Bhat Priya, Anderson Jeffrey B, Ghanayem Nancy S
Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex.
Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2023 Jan;165(1):287-298.e4. doi: 10.1016/j.jtcvs.2022.01.056. Epub 2022 Apr 2.
Prematurity, low birth weight, genetic syndromes, extracardiac conditions, and secondary cardiac lesions are considered high-risk conditions associated with mortality after stage 1 palliation. We report the impact of these conditions on outcomes from a prospective multicenter improvement collaborative.
The National Pediatric Cardiology Quality Improvement Collaborative Phase II registry was queried. Comorbid conditions were categorized and quantified to determine the cumulative burden of high-risk diagnoses on survival to the first birthday. Logistic regression was applied to evaluate factors associated with mortality.
Of the 1421 participants, 40% (575) had at least 1 high-risk condition. The aggregate high-risk group had lower survival to the first birthday compared with standard risk (76.2% vs 88.1%, P < .001). Presence of a single high-risk diagnosis was not associated with reduced survival to the first birthday (odds ratio, 0.71; confidence interval, 0.49-1.02, P = .066). Incremental increases in high-risk diagnoses were associated with reduced survival to first birthday (odds ratio, 0.23; confidence interval, 0.15-0.36, P < .001) for 2 and 0.17 (confidence interval, 0.10-0.30, P < .001) for 3 to 5 high-risk diagnoses. Additional analysis that included prestage 1 palliation characteristics and stage 1 palliation perioperative variables identified multiple high-risk diagnoses, poststage 1 palliation extracorporeal membrane oxygenation support (odds ratio, 0.14; confidence interval, 0.10-0.22, P < .001), and cardiac reoperation (odds ratio, 0.66; confidence interval, 0.45-0.98, P = .037) to be associated with reduced survival odds to the first birthday.
The presence of 1 high-risk diagnostic category was not associated with decreased survival at 1 year. Cumulative diagnoses across multiple high-risk diagnostic categories were associated with decreased odds of survival. Further patient accrual is needed to evaluate the impact of specific comorbid conditions within the broader high-risk categories.
早产、低出生体重、遗传综合征、心外疾病和继发性心脏病变被认为是与一期姑息治疗后死亡率相关的高危情况。我们报告了这些情况对一项前瞻性多中心改善合作研究结果的影响。
查询了国家儿科心脏病学质量改善合作研究二期登记处的数据。对合并症进行分类和量化，以确定高危诊断对一岁生存率的累积负担。应用逻辑回归评估与死亡率相关的因素。
在1421名参与者中，40%（575名）至少有一种高危情况。与标准风险组相比，总体高危组一岁生存率较低（76.2%对88.1%，P <.001）。单一高危诊断的存在与一岁生存率降低无关（比值比，0.71；置信区间，0.49 - 1.02，P = 0.066）。高危诊断数量的增加与一岁生存率降低相关（2种高危诊断时比值比，0.23；置信区间，0.15 - 0.36，P <.001；3至5种高危诊断时比值比，0.17；置信区间，0.10 - 0.30，P <.001）。纳入一期姑息治疗前特征和一期姑息治疗围手术期变量的进一步分析确定，多种高危诊断、一期姑息治疗后体外膜肺氧合支持（比值比，0.14；置信区间，0.10 - 0.22，P <.001）和心脏再次手术（比值比，0.66；置信区间，0.45 - 0.98，P = 0.037）与一岁生存率降低相关。
一种高危诊断类别的存在与一岁时生存率降低无关。多个高危诊断类别的累积诊断与生存率降低相关。需要进一步纳入患者以评估更广泛高危类别中特定合并症的影响。
