Division of Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA.
Department of Cardiology, Albany Medical Center, 22 New Scotland, Albany, NY, 12208, USA.
Pediatr Cardiol. 2023 Dec;44(8):1808-1814. doi: 10.1007/s00246-023-03171-4. Epub 2023 May 2.
Safety and acute outcomes for patients who need catheterization shortly after congenital cardiac surgery has been established; literature on mid-term outcomes is lacking. We sought to evaluate the mid-term outcomes of patients who undergo early postoperative cardiac catheterization. This is a retrospective cohort study of patients who underwent cardiac catheterization within 6 weeks of congenital cardiac surgery with longitudinal follow-up and assessment of mid-term outcomes. Multivariable analysis was utilized to relate variables of interest to outcomes. 99 patients underwent cardiac catheterizations within 6 weeks of cardiac surgery between January 2008 and September 2016. Forty-six (45.5%) interventional procedures were performed at a median age of 41 days (IQR 21-192) and a median weight of 3.9 kg (3.3-6.6). During a median follow-up duration of 4.24 years (1.6-5.6) in study survivors, 61% of patients remained free from the primary endpoint (death and/or transplant). Sixty-nine patients (69.7%) underwent an unplanned surgical or catheter procedure. Renal failure at catheterization (OR 280.5, p 0.0199), inotropic medication at catheterization (OR 14.8, p 0.002), and younger age were all significantly associated with meeting the primary endpoint. Patients requiring surgical intervention as an initial additional intervention underwent more unplanned re-interventions, while patients who survived to hospital discharge demonstrated favorable mortality, though with frequent need for re-intervention. In patients requiring early postoperative cardiac catheterization, renal failure, younger age, and need for inotropic support at catheterization are significantly associated with meeting the primary endpoint.
对于先天性心脏病手术后需要立即进行导管插入术的患者,其安全性和急性结果已经得到确立;但关于中期结果的文献却很缺乏。我们旨在评估早期术后行心脏导管术的患者的中期结果。这是一项回顾性队列研究,研究对象为在先天性心脏手术后 6 周内行心脏导管术且具有纵向随访结果和中期结局评估的患者。多变量分析用于将相关变量与结局联系起来。2008 年 1 月至 2016 年 9 月期间,99 例患者在心脏手术后 6 周内行心脏导管术。46 例(45.5%)介入性操作在中位数年龄 41 天(IQR 21-192)和中位数体重 3.9 公斤(3.3-6.6)时进行。在研究幸存者的中位随访时间 4.24 年(1.6-5.6)期间,61%的患者未达到主要终点(死亡和/或移植)。69 例患者(69.7%)行计划外手术或导管术。导管术时的肾衰竭(OR 280.5,p 0.0199)、导管术时使用正性肌力药物(OR 14.8,p 0.002)和年龄较小均与达到主要终点显著相关。作为初始附加干预的手术干预患者行更多计划外再干预,而存活至出院的患者死亡率较好,但频繁需要再次干预。在需要早期术后心脏导管术的患者中,肾衰竭、年龄较小和导管术时需要正性肌力支持与达到主要终点显著相关。