Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, North Lishi Road, Xicheng District, Beijing, 100037, China.
BMC Cardiovasc Disord. 2024 Oct 8;24(1):540. doi: 10.1186/s12872-024-04210-5.
Total cavopulmonary connection (TCPC) is a definitive palliative procedure for functionally univentricular congenital heart disease. The study aims to compare the impact of on-pump cardioplegic arrest and on-pump beating heart cardiopulmonary bypass (CPB) on the prognosis of pediatric patients undergoing extracardiac TCPC.
The medical data of patients (< 18 years) who underwent extracardiac TCPC with CPB between January 2008 and December 2020 in the cardiac surgery center were retrospectively analyzed. Depending on CPB strategies, the patients were assigned to the beating-heart (BH) and cardioplegic arrest (CA) groups. Data including baseline characteristics, intra/postoperative variables, and clinical outcomes were collected for analysis with 1:1 propensity score matching and multivariable stepwise logistic regressions.
Fifty-seven matched patient pairs were obtained. No significant difference existed between the two groups in the in-hospital mortality (3.5% vs. 1.8%, P = 1) and one-year survival rate (100% vs. 96.4%, P = 0.484). The BH group had significantly less intraoperative platelet transfusion (10 mL vs. 150 mL, P = 0.019) and blood loss (100 mL vs. 150 mL, P = 0.033) than the CA group. The CA group had significantly higher vasoactive-inotropic scores (P < 0.05) and longer postoperative ICU stays (2.0 d vs. 3.7 d, P = 0.017). No significant difference existed between the two groups in the incidence of postoperative adverse events.
Although both CPB strategies are safe and feasible for extracardiac TCPC, the BH technique would cause less intraoperative platelet transfusion and blood loss, and achieve faster early-term postoperative recovery.
全腔静脉肺动脉连接术（TCPC）是功能性单心室先天性心脏病的一种确定性姑息性手术。本研究旨在比较体外 TCPC 中使用停跳液心脏麻痹和不停跳心脏体外循环（CPB）对儿科患者预后的影响。
回顾性分析 2008 年 1 月至 2020 年 12 月在心脏外科中心接受体外 TCPC 并使用 CPB 的患者（<18 岁）的医疗数据。根据 CPB 策略，患者被分为心脏不停跳（BH）组和心脏停跳（CA）组。收集基线特征、围手术期变量和临床结局等数据，采用 1:1 倾向评分匹配和多变量逐步逻辑回归进行分析。
获得 57 对匹配患者。两组患者的院内死亡率（3.5%比 1.8%，P=1）和 1 年生存率（100%比 96.4%，P=0.484）无显著差异。BH 组术中血小板输注量（10 mL 比 150 mL，P=0.019）和出血量（100 mL 比 150 mL，P=0.033）明显少于 CA 组。CA 组血管活性药物评分明显较高（P<0.05），术后 ICU 停留时间明显较长（2.0 d 比 3.7 d，P=0.017）。两组术后不良事件发生率无显著差异。
尽管两种 CPB 策略对体外 TCPC 均安全可行，但 BH 技术可减少术中血小板输注和出血量，并实现更快的早期术后恢复。
