Beijing Anzhen Hospital, Capital Medical University, 2 Anding Road, Beijing, 100029, China.
Eur J Med Res. 2024 Feb 26;29(1):144. doi: 10.1186/s40001-024-01735-5.
To evaluate the outcomes after neonatal cardiac surgery at our institute, and identify factors associated with operative mortality.
We examined 224 neonates who underwent cardiac surgery at a single institution from 2013 to 2022. Relevant data, such as demographic information, operative details, and postoperative records, were gathered from medical and surgical records. Our primary focus was on the operative mortality.
Median age and weight at surgery were 12 (7-20) days and 3.4 (3.0-3.8) kg, respectively. Overall mortality was 14.3% (32/224). Mortality rates showed improvement over time (2013-2017 vs. 2018-2022), with rates decreasing from 21.9% to 10.6% (p = 0.023). ECMO use, extubation failure, lactate > 4.8 mmol/l and VIS > 15.5 on 24 h after operation were significantly associated with operative mortality, according to multivariate logistic regression analysis. Patients admitted to the cardiac intensive care unit (CICU) before surgery and those with prenatal diagnosis showed lower operative mortality. Median follow-up time of 192 hospital survivors was 28.0 (11.0-62.3) months. 10 patients experienced late deaths, and 7 patients required reinterventions after neonatal cardiac surgery. Risk factors for composite end-point of death and reintervention on multivariable analysis were: surgical period (HR = 0.230, 95% CI 0.081-0.654; p = 0.006), prolonged ventilation (HR = 4.792, 95% CI 1.296-16.177; p = 0.018) and STAT categories 3-5 (HR = 5.936, 95% CI 1.672-21.069; p = 0.006).
Our institution has observed improved surgical outcomes in neonatal cardiac surgery over the past five years with low mortality, but late death and reintervention remain necessary in some patients. The location and prenatal diagnosis prior to surgery may affect the outcomes of neonates undergoing congenital heart disease operations.
评估我院新生儿心脏手术后的结果，并确定与手术死亡率相关的因素。
我们检查了 2013 年至 2022 年在一家机构接受心脏手术的 224 名新生儿。从医疗和手术记录中收集了相关数据，如人口统计学信息、手术细节和术后记录。我们的主要关注点是手术死亡率。
中位手术年龄和体重分别为 12（7-20）天和 3.4（3.0-3.8）kg。总体死亡率为 14.3%（32/224）。死亡率随时间推移而改善（2013-2017 年与 2018-2022 年相比），死亡率从 21.9%降至 10.6%（p=0.023）。根据多变量逻辑回归分析，ECMO 使用、拔管失败、术后 24 小时乳酸>4.8mmol/L 和 VIS>15.5 与手术死亡率显著相关。术前入住心脏重症监护病房（CICU）和产前诊断的患者手术死亡率较低。224 例存活患者的中位随访时间为 28.0（11.0-62.3）个月。10 例患者发生晚期死亡，7 例患者在新生儿心脏手术后需要再次介入治疗。多变量分析中死亡和再次介入的复合终点的危险因素为：手术期（HR=0.230，95%CI 0.081-0.654；p=0.006）、延长通气（HR=4.792，95%CI 1.296-16.177；p=0.018）和 STAT 类别 3-5（HR=5.936，95%CI 1.672-21.069；p=0.006）。
在过去五年中，我们医院在新生儿心脏手术方面取得了更好的手术结果，死亡率较低，但一些患者仍需要晚期死亡和再次介入治疗。手术前的位置和产前诊断可能会影响先心病手术患儿的结局。
