Goldberg Sarah W, Chalak Chereen, Anderson Brett R, Elhoff Justin, Gaydos Stephanie, Lubert Adam M, Sassalos Peter, Gauvreau Kimberlee, Gurvitz Michelle
Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2025 Feb;119(2):398-405. doi: 10.1016/j.athoracsur.2024.09.037. Epub 2024 Oct 12.
As the life expectancy of patients with Down syndrome (DS) improves, the number of older patients with DS who require a cardiac surgical procedure for congenital heart disease will increase. Perioperative risk factors and outcomes in these patients are unknown.
In a multicenter retrospective study, teenaged and adult patients with DS who underwent a cardiac surgical procedure between 2008 and 2018 were matched by age and surgical procedure with patients who did not have DS. Demographic, medical, and surgical characteristics were compared. Outcome measures were length of stay (LOS), duration of mechanical ventilation, need for noninvasive positive pressure ventilation and reintubation, additional cardiac interventions, postoperative infections, and early postoperative mortality. Risk factors for extended hospital LOS (>10 days) were explored using multivariable logistic regression.
The study compared 121 patients with DS with 121 patients who did not have DS. Patients with DS had a longer median LOS (7 days vs 5 days; P < .001), a longer duration of mechanical ventilation (12.5 hours vs 6.7 hours; P < .001), greater need for noninvasive positive pressure ventilation or reintubation (26% vs 4%; P < .001), and a higher likelihood of postoperative infections (10% vs 2%; P = .035). There was no early mortality. Preoperative risk factors for extended LOS for patients with DS included pulmonary medication use (odds ratio [OR], 4.0; P = .046), a history of immunodeficiency (OR, 10.4; P = .004), or moderate or greater tricuspid regurgitation (OR, 12.7; P < .001).
Teenaged and adult patients with DS who underwent congenital a cardiac surgical procedure had a longer hospital LOS and more postoperative respiratory and infectious complications compared with patients who did not have DS, without increased mortality. A cardiac surgical procedure can be performed safely in older patients with DS. Management of pulmonary disease, immunodeficiency, and tricuspid regurgitation may mitigate risk.
随着唐氏综合征（DS）患者预期寿命的延长，因先天性心脏病而需要进行心脏外科手术的老年DS患者数量将会增加。这些患者围手术期的危险因素和预后情况尚不清楚。
在一项多中心回顾性研究中，将2008年至2018年间接受心脏外科手术的青少年及成年DS患者，按年龄和手术方式与非DS患者进行匹配。比较两组患者的人口统计学、医学和手术特征。观察指标包括住院时间（LOS）、机械通气时间、无创正压通气及再次插管需求、额外的心脏干预措施、术后感染及术后早期死亡率。采用多变量逻辑回归分析延长住院时间（>10天）的危险因素。
该研究共纳入121例DS患者和121例非DS患者。DS患者的中位住院时间更长（7天对5天；P <.001），机械通气时间更长（12.5小时对6.7小时；P <.001），无创正压通气或再次插管的需求更大（26%对4%；P <.001），术后感染的可能性更高（10%对2%；P =.035）。未发生早期死亡。DS患者延长住院时间的术前危险因素包括使用肺部药物（比值比[OR]，4.0；P =.046）、免疫缺陷病史（OR，10.4；P =.004）或中度及以上三尖瓣反流（OR，12.7；P <.001）。
与非DS患者相比，接受先天性心脏外科手术的青少年及成年DS患者住院时间更长，术后呼吸系统和感染并发症更多，但死亡率并未增加。老年DS患者可安全地进行心脏外科手术。对肺部疾病、免疫缺陷和三尖瓣反流的管理可能会降低风险。
