Cattapan Claudia, Jacobs Jeffrey P, Bleiweis Mark S, Sarris George E, Tobota Zdzislaw, Guariento Alvise, Maruszewski Bohdan, Staffa Steven J, Zurakowski David, Vida Vladimiro L
Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida.
Ann Thorac Surg. 2025 Apr;119(4):880-889. doi: 10.1016/j.athoracsur.2024.07.023. Epub 2024 Aug 3.
We evaluated outcomes of neonatal cardiac surgery at hospitals affiliated with the European Congenital Heart Surgeons Association (ECHSA).
All patients ≤30 days of life undergoing a cardiac surgical procedure during a 10-year period between January 2013 and December 2022 were selected from the ECHSA Congenital Database. Reoperations during the same hospitalization, percutaneous procedures, and noncardiac surgical procedures were excluded. We identified 12 benchmark operations. Primary outcomes were 30-day mortality and in-hospital mortality. Multivariable logistic regression analysis was performed to determine independent factors associated with higher mortality. Mortality between the first 5 years and second 5 years was also compared.
The overall number of neonatal operations from 2013 to 2022 was 30,931, and 22,763 patients met the inclusion criteria of the study. The 4 most common procedures were arterial switch operation (3520 of 22,763 [15.5%]), aortic coarctation repair (3204 of 22,763 [14.1%]), shunt procedure (2351 of 22,763 [10.3%]), and Norwood operation (2115 of 22,763 [9.23%]). The 30-day mortality rate was as follows: overall population, 5.9% (1342 of 22,763); arterial switch, 3.13% (110 of 3520); Norwood operation, 16.0% (339 of 2115); and hybrid operation, 15.4% (94 of 609). In-hospital mortality rate was as follows: overall population, 9.1% (2074 of 22,763); arterial switch, 4.12% (145 of 3520); Norwood operation, 24.7% (523 of 2115); and hybrid operation, 30.5% (186 of 609). Multivariable analysis revealed that major factors impacting mortality were high-risk procedures (adjusted odds ratio, 2.74; 95% CI, 2.33-3.23; P < .001), and the need for extracorporeal membrane oxygenation (11.8; 95% CI, 9.9-14; P < .001).
Neonatal cardiac surgery continues to pose a significant challenge, with notable mortality, particularly for neonates with functionally univentricular physiology. These data can serve as important benchmarks across Europe and offer insights regarding opportunities for improvement.
我们评估了欧洲先天性心脏病外科医生协会（ECHSA）附属医院的新生儿心脏手术结果。
从ECHSA先天性数据库中选取2013年1月至2022年12月这10年间所有年龄≤30天接受心脏手术的患者。排除同一住院期间的再次手术、经皮手术和非心脏外科手术。我们确定了12种基准手术。主要结局是30天死亡率和住院死亡率。进行多变量逻辑回归分析以确定与较高死亡率相关的独立因素。还比较了前5年和后5年的死亡率。
2013年至2022年新生儿手术总数为30,931例，22,763例患者符合研究纳入标准。4种最常见的手术是动脉调转术（22,763例中的3520例[15.5%]）、主动脉缩窄修复术（22,763例中的3204例[14.1%]）、分流手术（22,763例中的2351例[10.3%]）和诺伍德手术（22,763例中的2115例[9.23%]）。30天死亡率如下：总体人群为5.9%（22,763例中的1342例）；动脉调转术为3.13%（3520例中的110例）；诺伍德手术为16.0%（2115例中的339例）；杂交手术为15.4%（609例中的94例）。住院死亡率如下：总体人群为9.1%（22,763例中的2074例）；动脉调转术为4.12%（3520例中的145例）；诺伍德手术为24.7%（2115例中的523例）；杂交手术为30.5%（609例中的186例）。多变量分析显示，影响死亡率的主要因素是高风险手术（调整比值比，2.74；95%CI，2.33 - 3.23；P <.001）以及体外膜肺氧合的需求（11.8；95%CI，9.9 - 14；P <.001）。
新生儿心脏手术仍然是一项重大挑战，死亡率显著，尤其是对于功能单心室生理的新生儿。这些数据可作为全欧洲的重要基准，并为改进机会提供见解。
