Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego, CA, USA.
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
World J Pediatr Congenit Heart Surg. 2024 Nov;15(6):724-730. doi: 10.1177/21501351241269924. Epub 2024 Sep 5.
Significant atrioventricular valve dysfunction can be associated with mortality or need for transplant in functionally univentricular heart patients undergoing staged palliation. The purposes of this study are to characterize the impact of concomitant atrioventricular valve intervention on outcomes at each stage of single ventricle palliation and to identify risk factors associated with poor outcomes in these patients. The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for functionally univentricular heart patients undergoing single ventricle palliation from 2013 through 2022. Separate analyses were performed on cohorts corresponding to each stage of palliation (1: initial palliation; 2: superior cavopulmonary anastomosis; 3: Fontan procedure). Bivariate analysis of demographics, diagnoses, comorbidities, preoperative risk factors, operative characteristics, and outcomes with and without concomitant atrioventricular valve intervention was performed. Multiple logistic regression was used to identify predictors associated with operative mortality or major morbidity. Concomitant atrioventricular valve intervention was associated with an increased risk of operative mortality or major morbidity for each cohort (cohort 1: 62% vs 46%, < .001; cohort 2: 37% vs 19%, < .001; cohort 3: 22% vs 14%, < .001). Black race in cohort 1 (odds ratio [OR] 3.151, 95% CI 1.181-9.649, = .03) and preterm birth in cohort 2 (OR 1.776, 95% CI 1.049-3.005, = .032) were notable predictors of worse morbidity or mortality. Concomitant atrioventricular valve intervention is a risk factor for operative mortality or major morbidity at each stage of single ventricle palliation. Several risk factors are associated with these outcomes and may be useful in guiding decision-making.
在接受分阶段姑息治疗的功能性单心室心脏患者中，严重的房室瓣功能障碍可导致死亡率增加或需要进行移植。本研究的目的是描述房室瓣同期干预对单心室姑息治疗各阶段结局的影响，并确定这些患者不良结局的相关危险因素。从 2013 年至 2022 年，使用胸外科医师学会先天性心脏病数据库查询接受单心室姑息治疗的功能性单心室心脏患者。对每个姑息阶段（1：初始姑息治疗；2：上腔静脉-肺动脉吻合术；3：Fontan 手术）的队列分别进行分析。对伴有和不伴有房室瓣同期干预的患者的人口统计学、诊断、合并症、术前危险因素、手术特点和结局进行了单变量分析。采用多因素逻辑回归分析确定与手术死亡率或主要并发症相关的预测因素。同期房室瓣干预与每个队列的手术死亡率或主要并发症风险增加相关（队列 1：62%比 46%， < .001；队列 2：37%比 19%， < .001；队列 3：22%比 14%， < .001）。队列 1 中的黑人种族（比值比 [OR] 3.151，95%可信区间 1.181-9.649， = .03）和队列 2 中的早产儿（OR 1.776，95%可信区间 1.049-3.005， = .032）是不良发病率或死亡率的显著预测因素。同期房室瓣干预是单心室姑息治疗各阶段手术死亡率或主要并发症的危险因素。有几个危险因素与这些结局相关，可能有助于指导决策。
