Yılmaz Emine Hekim, Yurtseven Nurgül, Korun Oktay, Çiçek Murat, Karadağ Hüseyin, Sürücü Murat, Demir İbrahim Halil, Aydemir Numan Ali, Çelebi Ahmet
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye.
Department of Anesthesia and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye.
Turk Kardiyol Dern Ars. 2024 Dec;52(8):567-573. doi: 10.5543/tkda.2024.77449.
Postoperative junctional ectopic tachycardia (JET) is usually a self-limiting condition; however, when combined with atrioventricular dissociation and postoperative ventricular dysfunction, it may increase morbidity and mortality. This study aimed to determine the overall incidence of JET following congenital heart surgery, to identify patient and procedure-related risk factors, and to evaluate the clinical impact of JET on outcomes.
The records of 2,814 patients who underwent cardiac surgery over a five-year period were reviewed retrospectively to identify those with JET. For each patient diagnosed with JET, two controls who underwent surgery during the same period were selected to compare possible risk factors and outcomes.
The incidence of JET following congenital heart surgery was 2.66% in this large cohort. Univariate analyses revealed statistically significant associations between JET and factors such as young age, small body weight, high vasoactive inotropic score, operations involving the ventricular septum, surgical complexity score, increased cardiopulmonary bypass time, delayed sternal closure, extracorporeal membrane oxygenation (ECMO) requirement, and increased risk of postoperative JET. In multivariate analysis only the association between surgeries involving the ventricular septum, ECMO requirement, and increased risk of JET persisted. Compared to controls, patients with JET experienced prolonged intubation times, longer stays in the intensive care unit and hospital, more frequent unplanned re-interventions, and higher mortality rates.
Junctional ectopic tachycardia can lead to serious hemodynamic consequences in patients following congenital heart surgery and is associated with poorer clinical outcomes. Both patient and procedure-related factors contribute to the overall risk of developing JET. Identifying associations and predictors of JET can help improve patient outcomes.
术后交界性异位性心动过速（JET）通常为自限性疾病；然而，当合并房室分离和术后心室功能障碍时，可能会增加发病率和死亡率。本研究旨在确定先天性心脏病手术后JET的总体发生率，识别与患者和手术相关的危险因素，并评估JET对预后的临床影响。
回顾性分析2814例在五年期间接受心脏手术患者的记录，以识别患有JET的患者。对于每例诊断为JET的患者，选择同期接受手术的两名对照者，以比较可能的危险因素和预后。
在这个大型队列中，先天性心脏病手术后JET的发生率为2.66%。单因素分析显示，JET与年龄小、体重轻、血管活性药物评分高、涉及室间隔的手术、手术复杂程度评分、体外循环时间延长、胸骨延迟闭合、体外膜肺氧合（ECMO）需求以及术后JET风险增加等因素之间存在统计学上的显著关联。多因素分析中，仅涉及室间隔的手术、ECMO需求与JET风险增加之间的关联仍然存在。与对照组相比，JET患者的插管时间延长、在重症监护病房和医院的住院时间更长、计划外再次干预更频繁，死亡率更高。
交界性异位性心动过速可导致先天性心脏病手术后患者出现严重的血流动力学后果，并与较差的临床预后相关。患者因素和手术相关因素均导致发生JET的总体风险增加。识别JET的关联因素和预测因素有助于改善患者预后。
