Bhende Vishal V, Sharma Tanishq S, Trivedi Bhadra Y, Kumar Amit, Parmar Dushyant M, Nerurkar Paresh, Shah Prachi M, Fumakiya Naresh J, Majmudar Hardil P, Pathan Sohilkhan R
Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital Bhaikaka University Gujarat India.
Department of Pediatric Cardiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital Bhaikaka University Gujarat India.
Health Sci Rep. 2022 Oct 29;5(6):e909. doi: 10.1002/hsr2.909. eCollection 2022 Nov.
Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study.
This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored.
The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively.
RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective.
心内修复术后的心脏结局由多种因素决定，而右心室（RV）功能障碍被认为是其中的关键因素，因为仅有少数研究尝试对其术后情况进行评估。右心室功能被认为是先天性心脏病患者的重要预后因素；因此，评估右心室功能是本研究的主要目的。
这是一项前瞻性单中心队列研究，对2019年1月至2022年1月期间接受心内修复术的50例先天性心脏病（CHD）患儿进行了研究。所有患者在术后1小时、24小时和48小时通过三尖瓣环平面收缩期位移（TAPSE）和面积变化分数（FAC）进行右心室功能的超声心动图评估。术后评估术前和术后右心室压力、体外循环（CPB）和主动脉阻断（ACC）时间。同样，还监测了通气重症监护病房（ICU）和住院时间以及纵隔引流情况。
术前和术后右心室压力的平均值±标准差分别为49.1±16.12和42.7±2.9 mmHg，而术前和术后肺动脉压力的平均值±标准差分别为30.4±2.6和24.2±12.9 mmHg，P值分别<0.002和<0.001。CPB和ACC时间的平均值±标准差分别为120.92±74.17和78.44±50.5分钟，而通气时间、纵隔胸腔引流、ICU和住院时间的平均值±标准差分别为30.36±54.04、43.78±46.7分钟、5.9±4.01小时和10.3±4.83小时。
右心室功能障碍在恢复时间延长和手术时间延长方面起重要作用，但其影响大多是短暂的。使用TAPSE和FAC方法对评估术后结局有价值，且前者被证明更有效。
