Noma Mio, Hirata Yasutaka, Hirahara Norimichi, Suzuki Takaaki, Miyata Hiroaki, Hiramatsu Yuji, Yoshimura Yukihiro, Takamoto Shinichi
Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Department of Cardiac Surgery, The University of Tokyo School of Medicine, Tokyo, Japan.
JTCVS Open. 2022 Jan 22;9:237-243. doi: 10.1016/j.xjon.2022.01.001. eCollection 2022 Mar.
Pericardial effusion after cardiac surgery remains an important cause of morbidity and mortality. We describe the risk factors of pericardial effusion after congenital heart surgery through analyzing data from a nationwide, multi-institutional registry.
The Japan Congenital Cardiovascular Surgery Database, which reflects routine clinical care in Japan, was used for this retrospective cohort study. Multivariable regression analysis was done after univariable comparison of patients with pericardial effusion and no pericardial effusion.
The study enrolled 64,777 patients registered with the Japan Congenital Cardiovascular Surgery Database between 2008 and 2016; 909 of these had postoperative pericardial effusion (1.4%) and were analyzed along with 63,868 patients without pericardial effusion. Univariable analysis found no difference between the groups in terms of gender, early delivery, or preoperative mechanical ventilatory support. In the pericardial effusion group, cardiopulmonary bypass use was lower (58.4% vs 62.1%), whereas the cardiopulmonary bypass time (176.9 vs 139.9 minutes) and aortic crossclamp time (75.1 vs 62.2 minutes) were longer, and 30-day mortality was higher (4.1% vs 2.2%). Multivariable analysis identified trisomy 21 (odds ratio, 1.54), 22q.11 deletion (odds ratio, 2.17), first-time cardiac surgery (odds ratio, 2.01), and blood transfusion (odds ratio, 1.43) as independent risk factors of postoperative pericardial effusion. In contrast, neonates, infants, ventricular septal defect, atrial septal defect, tetralogy of Fallot repair, and arterial switch operation were correlated with a low risk of pericardial effusion development.
The incidence of postoperative pericardial effusion in congenital cardiac surgery was 1.4%. Trisomy 21, 22q.11 deletion, first-time cardiac surgery, and blood transfusion were identified as the principal factors predicting the need for pericardial effusion drainage.
心脏手术后心包积液仍然是发病和死亡的重要原因。我们通过分析来自全国多机构登记处的数据，描述先天性心脏手术后心包积液的危险因素。
本回顾性队列研究使用反映日本常规临床护理情况的日本先天性心血管手术数据库。在对有心包积液和无心包积液的患者进行单变量比较后，进行多变量回归分析。
该研究纳入了2008年至2016年间在日本先天性心血管手术数据库登记的64777例患者；其中909例术后发生心包积液（1.4%），并与63868例无心包积液的患者一起进行分析。单变量分析发现，两组在性别、早产或术前机械通气支持方面无差异。在心包积液组中，体外循环的使用率较低（58.4%对62.1%），而体外循环时间（176.9对139.9分钟）和主动脉阻断时间（75.1对62.2分钟）更长，30天死亡率更高（4.1%对2.2%）。多变量分析确定21三体综合征（比值比，1.54）、22q.11缺失（比值比，2.17）、首次心脏手术（比值比，2.01）和输血（比值比，1.43）是术后心包积液的独立危险因素。相比之下，新生儿、婴儿、室间隔缺损、房间隔缺损、法洛四联症修复术和动脉调转术与心包积液发生风险较低相关。
先天性心脏手术术后心包积液的发生率为1.4%。21三体综合征、22q.11缺失、首次心脏手术和输血被确定为预测心包积液引流需求的主要因素。
