Gagliardi Maria Giulia, Formigari Roberto, Perrone Marco Alfonso, Pomiato Elettra, Fanisio Francesca, Panebianco Mario, Barracano Rosaria, Guccione Paolo, Palmieri Rosalinda, Raponi Massimiliano, Galletti Lorenzo
Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
Division of Cardiology and Cardio Lab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
J Cardiovasc Dev Dis. 2023 Jul 25;10(8):314. doi: 10.3390/jcdd10080314.
Adults with congenital heart disease (ACHD) are a growing population needing ongoing care. The aim of this study was to investigate if a dedicated ACHD team impacted the timing and indication of invasive cardiology procedures in these patients at our hospital.
Our retrospective single-center study enrolled adult patients with moderate or complex congenital heart disease and with at least one cardiac catheterization between January 2010 and December 2021. According to the period, procedures were labeled as group A (2010 to 2015) or group B (2016 to 2021) and further divided into diagnostic (DCC) and interventional cardiac catheterizations (ICC).
594 patients were eligible for the study. Both DCC ( < 0.05) and ICC increased between groups A and B ( < 0.05). In group B: Fontan patients accounted for the majority of DCC ( < 0.001), while DCC decreased in arterial switch repair ( < 0.001). In Fontan patients, conduit stenting was prevalent ( < 0.001), while fenestration closures dropped ( < 0.01). In patients with tetralogy of Fallot and native outflow tract, percutaneous pulmonary valve implantations (PPVI) increased, with a concurrent reduction in pulmonary valve replacements ( < 0.001 vs. surgical series). In right ventricular conduits, ICC increased ( < 0.01), mainly due to PPVI. Among Mustard/Senning patients, baffle stenting increased from Group A to Group B ( < 0.001). In patients with pulmonary atresia and biventricular repair, ICC often increased for pulmonary artery stenting.
A dedicated working group could improve ACHD patients' indications for interventional procedures, leading to tailored treatment, better risk stratification and optimizing time until heart transplantation.
患有先天性心脏病的成年人（ACHD）数量不断增加，需要持续护理。本研究的目的是调查专门的ACHD团队是否会影响我院这些患者侵入性心脏病学手术的时机和指征。
我们的回顾性单中心研究纳入了2010年1月至2021年12月期间患有中度或复杂性先天性心脏病且至少进行过一次心导管检查的成年患者。根据时间段，手术被标记为A组（2010年至2015年）或B组（2016年至2021年），并进一步分为诊断性心导管检查（DCC）和介入性心导管检查（ICC）。
594例患者符合研究条件。A组和B组之间DCC（<0.05）和ICC均增加（<0.05）。在B组中：Fontan患者占DCC的大多数（<0.001），而动脉调转术修复中的DCC减少（<0.001）。在Fontan患者中，导管支架置入术很普遍（<0.001），而开窗闭合术减少（<0.01）。在法洛四联症和原生流出道患者中，经皮肺动脉瓣植入术（PPVI）增加，同时肺动脉瓣置换术减少（与手术系列相比<0.001）。在右心室导管中，ICC增加（<0.01），主要是由于PPVI。在Mustard/Senning患者中，挡板支架置入术从A组到B组增加（<0.001）。在肺动脉闭锁和双心室修复患者中，ICC常因肺动脉支架置入术而增加。
一个专门的工作组可以改善ACHD患者介入手术的指征，从而实现个性化治疗、更好的风险分层并优化心脏移植前的时间。
