Averin Konstantin, Ryerson Lindsay, Hajihosseini Morteza, Dinu Irina A, Freed Darren H, Bond Gwen, Joffe Ari R, Jonker De Villiers, Hendson Leonora, Robertson Charlene M T, Atallah Joseph
Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Division of Critical Care, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
JTCVS Open. 2023 Mar 22;14:417-425. doi: 10.1016/j.xjon.2023.03.007. eCollection 2023 Jun.
In infants with single-ventricle congenital heart disease, prematurity and low weight at the time of the Norwood operation are risk factors for mortality. Reports assessing outcomes (including neurodevelopment) post Norwood palliation in infants ≤2.5 kg are limited.
All infants who underwent a Norwood-Sano procedure between 2004 and 2019 were identified. Infants ≤2.5 kg at the time of the operation (cases) were matched 3:1 with infants >3.0 kg (comparisons) for year of surgery and cardiac diagnosis. Demographic and perioperative characteristics, survival, and functional and neurodevelopmental outcomes were compared.
Twenty-seven cases (mean ± standard deviation: weight 2.2 ± 0.3 kg and age 15.6 ± 14.1 days at surgery) and 81 comparisons (3.5 ± 0.4 kg and age 10.9 ± 7.9 days at surgery) were identified. Post-Norwood, cases had a longer time to lactate ≤2 mmol/L (33.1 ± 27.5 vs 17.9 ± 12.2 hours, < .001), longer duration of ventilation (30.5 ± 24.5 vs 18.6 ± 17.5 days, = .005), greater need for dialysis (48.1% vs 19.8%, = .007), and greater need for extracorporeal membrane oxygenation support (29.6% vs 12.3%, = .004). Cases had significantly greater postoperative (in-hospital) (25.9% vs 1.2%, < .001) and 2-year (59.2% vs 11.1%, < .001) mortality. Neurodevelopmental assessment showed the following for cases versus comparisons, respectively: cognitive delay (18.2% vs 7.9%, = .272), language delay (18.2% vs 11.1%, = .505), and motor delay (27.3% vs 14.3%, = .013).
Infants ≤2.5 kg at Norwood-Sano palliation have significantly increased postoperative morbidity and mortality up to 2-year follow-up. Neurodevelopmental motor outcomes were worse in these infants. Additional studies are warranted to assess the outcome of alternative medical and interventional treatment plans in this patient population.
在单心室先天性心脏病婴儿中，诺伍德手术时早产和低体重是死亡的危险因素。评估体重≤2.5 kg婴儿诺伍德姑息治疗后结局（包括神经发育）的报告有限。
确定2004年至2019年间所有接受诺伍德 - 佐野手术的婴儿。手术时体重≤2.5 kg的婴儿（病例组）与体重>3.0 kg的婴儿（对照组）按3:1进行手术年份和心脏诊断匹配。比较人口统计学和围手术期特征、生存率以及功能和神经发育结局。
确定了27例病例（平均±标准差：手术时体重2.2±0.3 kg，年龄15.6±14.1天）和81例对照（手术时体重3.5±0.4 kg，年龄10.9±7.9天）。诺伍德手术后，病例组达到乳酸≤2 mmol/L的时间更长（33.1±27.5小时对17.9±12.2小时，<.001），通气持续时间更长（30.5±24.5天对18.6±17.5天，=.005），透析需求更大（48.1%对19.8%，=.007），体外膜肺氧合支持需求更大（29.6%对12.3%，=.004）。病例组术后（住院期间）死亡率显著更高（25.9%对1.2%，<.001），2年死亡率也更高（59.2%对11.1%，<.001）。神经发育评估显示病例组与对照组相比，认知延迟分别为（18.2%对7.9%，=.272），语言延迟为（18.2%对11.1%，=.505），运动延迟为（27.3%对14.3%，=.013）。
诺伍德 - 佐野姑息治疗时体重≤2.5 kg的婴儿术后发病率和死亡率在长达2年的随访中显著增加。这些婴儿的神经发育运动结局更差。有必要进行更多研究以评估该患者群体中替代医疗和介入治疗方案的结局。
