Hamilton A Rebecca L, Yuki Koichi, Fynn-Thompson Francis, DiNardo James A, Odegard Kirsten C
Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, Hospital for Sick Children; Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada; Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden.
Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden.
J Cardiothorac Vasc Anesth. 2025 Mar;39(3):692-701. doi: 10.1053/j.jvca.2024.11.008. Epub 2024 Nov 14.
Perioperative management strategies and outcomes for low-risk congenital heart disease (CHD) surgery vary between institutions. To date, no consensus exists on standardized management for pediatric patients undergoing cardiac surgery. This study seeks to benchmark the perioperative management of 4 common CHD lesions and explore clinical factors affecting postoperative outcomes.
A retrospective review of CHD procedures performed between 2015 and 2020.
The study was conducted at a single academic tertiary pediatric hospital.
All patients presenting for repair of ventricular septal defects (VSDs), complete atrioventricular canal defects, tetralogy of Fallot (TOF), and transposition of the great arteries (TGA) were reviewed.
Demographic and clinical data were collected; clinical outcomes were defined as postoperative length of ventilation (LOV) and hospital length of stay, divided into reference and prolonged course groups analyzed for variables associated with differences in outcomes.
We selected 931 patients for review. Prolonged length of ventilation and length of stay in all cohorts were associated with longer operative, cardiopulmonary bypass, and cross-clamp times; higher intraoperative requirements for inotropic support; more blood transfusions and higher opioid administration; lower pH preoperatively and higher lactic acid postoperatively. Worse outcomes were associated with younger age in VSD, older age in TGA, and lower weight in TOF and TGA. Worse outcomes were also associated with a higher preoperative hematocrit in VSD and TOF and elevated preoperative blood glucose in VSD and TGA.
A better understanding of clinical factors affecting outcomes may facilitate streamlining perioperative management strategies for pediatric patients undergoing low-risk cardiac surgery.
低风险先天性心脏病（CHD）手术的围手术期管理策略和结果在不同机构之间存在差异。迄今为止，对于接受心脏手术的儿科患者，尚无标准化管理的共识。本研究旨在对4种常见CHD病变的围手术期管理进行基准评估，并探讨影响术后结果的临床因素。
对2015年至2020年期间进行的CHD手术进行回顾性研究。
该研究在一家单一的学术三级儿科医院进行。
对所有前来修复室间隔缺损（VSD）、完全性房室通道缺损、法洛四联症（TOF）和大动脉转位（TGA）的患者进行了回顾。
收集人口统计学和临床数据；临床结果定义为术后通气时间（LOV）和住院时间，分为参考组和延长病程组，分析与结果差异相关的变量。
我们选择了931例患者进行回顾。所有队列中通气时间延长和住院时间延长均与手术时间、体外循环时间和主动脉阻断时间较长有关；术中对血管活性药物支持的需求较高；输血较多且阿片类药物使用量较高；术前pH值较低且术后乳酸水平较高。VSD患者年龄较小、TGA患者年龄较大、TOF和TGA患者体重较低与较差的结果相关。VSD和TOF患者术前血细胞比容较高、VSD和TGA患者术前血糖升高也与较差的结果相关。
更好地了解影响结果的临床因素可能有助于简化接受低风险心脏手术的儿科患者的围手术期管理策略。
