Division of Cardiology, Department of Pediatrics (J.L.W., C.L.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Medical Social Sciences (J.L.W., M.M.D.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Circ Cardiovasc Qual Outcomes. 2023 Sep;16(9):e009638. doi: 10.1161/CIRCOUTCOMES.122.009638. Epub 2023 Aug 4.
The relationship between the prenatal diagnosis of congenital heart defects (CHDs) and age at CHD surgery is poorly understood, despite the known relationships between age at surgery and long-term outcomes. The objective of this study was to determine the associations between prenatal diagnosis of CHD and age at surgery, and whether these associations differ for critical and noncritical CHDs.
This is a cohort analysis of patients aged 0 to 9 years who received their initial cardiac surgery at Ann & Robert H. Lurie Children's Hospital of Chicago between 2015 and 2021 with prenatal diagnosis as the exposure variable. All data were obtained from the locally maintained Society of Thoracic Surgeons Congenital Heart Surgery Database at Lurie Children's Hospital. We used multivariable fixed effects regression models to estimate the strength of the association of prenatal diagnosis with age at surgery among patients with critical (surgery ≤60 days) and noncritical (surgery >60 days) CHDs.
Of 1131 individuals who met inclusion criteria, 532 (47%) had a prenatal diagnosis, 428 (38%) had critical CHDs, 533 (47%) were female, and the median age at surgery was 119 days (interquartile range, 11-309 days). After controlling for demographics, comorbidities, and surgical complexity, the mean age at surgery was significantly younger in those with prenatally versus postnatally diagnosed critical CHD (7.1 days sooner, <0.001) and noncritical CHDs (atrial septal defects [12.4 months sooner, =0.037], ventricular septal defects [6.0 months sooner, <0.003], and noncritical coarctation of the aorta [1.8 months sooner, =0.010]).
Younger age at CHD surgery, which is associated with postsurgical neurodevelopmental and physical outcomes, is significantly associated with prenatal CHD diagnosis. This relationship was identified for both critical and noncritical CHDs.
尽管已知手术年龄与长期结果之间存在关系，但先天性心脏病（CHD）的产前诊断与手术年龄之间的关系仍知之甚少。本研究的目的是确定 CHD 的产前诊断与手术年龄之间的关联，以及这些关联是否因危急型和非危急型 CHD 而有所不同。
这是一项队列分析，研究对象为 2015 年至 2021 年期间在芝加哥安与罗伯特·H·卢里儿童医院接受首次心脏手术的 0 至 9 岁患者，将产前诊断作为暴露变量。所有数据均来自卢里儿童医院本地维护的胸外科医师学会先天性心脏病外科学数据库。我们使用多变量固定效应回归模型来估计危急型（手术≤60 天）和非危急型（手术>60 天）CHD 患者中产前诊断与手术年龄之间的关联强度。
在符合纳入标准的 1131 名患者中，532 名（47%）有产前诊断，428 名（38%）患有危急型 CHD，533 名（47%）为女性，手术中位年龄为 119 天（四分位间距，11-309 天）。在校正了人口统计学、合并症和手术复杂性后，与产后诊断的危急型 CHD（早 7.1 天，<0.001）和非危急型 CHD（房间隔缺损[早 12.4 个月，=0.037]、室间隔缺损[早 6.0 个月，<0.003]和非危急型主动脉缩窄[早 1.8 个月，=0.010]）相比，产前诊断的危急型 CHD 和非危急型 CHD 的手术年龄显著更小。
与术后神经发育和身体结果相关的 CHD 手术年龄更年轻，与 CHD 的产前诊断显著相关。这种关系在危急型和非危急型 CHD 中均有发现。
