Ghasemi Shayan Ramin, Fatollahzadeh Dizaji Mahsa, Sajjadian Fakhrosadat
Radiology Department, Paramedical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
Islamic Azad University, Tabriz, Iran.
Langenbecks Arch Surg. 2025 Mar 31;410(1):113. doi: 10.1007/s00423-025-03673-0.
Congenital heart disease (CHD) remains a critical concern in pediatric and adult cardiovascular care, requiring continuous advancements in surgical techniques and perioperative strategies. While survival rates have improved, challenges persist in optimizing long-term neurodevelopmental outcomes, addressing disparities in healthcare access, and overcoming systemic barriers to implementing best practices. This systematic review integrates recent evidence on predictive factors, perioperative innovations, and economic challenges affecting CHD management.
A systematic review was conducted, analyzing data from 27 observational studies, including retrospective and prospective cohort studies, as well as case reports, sourced from diverse geographic and clinical settings. Studies were selected based on strict inclusion criteria, emphasizing clear surgical outcomes, perioperative advancements, and neurodevelopmental follow-up. Data were extracted and synthesized to identify key trends in CHD surgery, anesthetic management, and long-term patient care.
Key findings include: • Neurodevelopmental Outcomes: Long-term follow-up studies identified associations between prolonged ICU stays, intraoperative cerebral oxygenation deficits, and developmental delays. Hearing loss was reported in 21.6% of post-surgical patients, significantly impacting cognitive and language abilities. • Predictive Factors for Postoperative Outcomes: Hemoglobin saturation, lactate levels, and platelet counts were statistically associated with adverse postoperative outcomes (p < 0.05), reinforcing the need for preoperative risk stratification. • Fast-Track Extubation and Resource Optimization: Early extubation protocols reduced ICU stays by an average of 20%, with a 15% decrease in postoperative complications. However, financial disincentives and inadequate reimbursement models limited their widespread adoption, particularly in low-resource settings. • Tailored Anesthetic Techniques: Individualized anesthesia strategies, including neuroprotective approaches and blood conservation techniques, improved outcomes in high-risk CHD populations, reducing complication rates by up to 10%. • Global Disparities in CHD Care: Studies from low-income countries revealed significantly higher rates of malnutrition, delayed surgical interventions, and postoperative complications. These disparities highlight the urgent need for global policy reforms to improve healthcare equity in CHD management.
This review highlights the necessity of integrating predictive analytics, multidisciplinary approaches, and healthcare system reforms to enhance CHD management. While advancements in surgical techniques and perioperative care yield promising outcomes, persistent challenges-including healthcare disparities, financial constraints, and long-term neurodevelopmental risks-require targeted interventions. Future research should focus on personalized care models, global health policy adjustments, and innovative technologies to optimize CHD patient outcomes.
先天性心脏病（CHD）仍是儿科和成人心血管护理中的一个关键问题，需要手术技术和围手术期策略不断进步。虽然生存率有所提高，但在优化长期神经发育结局、解决医疗服务可及性差异以及克服实施最佳实践的系统性障碍方面，挑战依然存在。本系统评价整合了有关影响CHD管理的预测因素、围手术期创新和经济挑战的最新证据。
进行了一项系统评价，分析了来自27项观察性研究的数据，包括回顾性和前瞻性队列研究以及病例报告，这些研究来自不同的地理和临床环境。研究根据严格的纳入标准进行选择，重点关注明确的手术结局、围手术期进展和神经发育随访。提取并综合数据以确定CHD手术、麻醉管理和长期患者护理的关键趋势。
主要发现包括：•神经发育结局：长期随访研究确定了ICU住院时间延长、术中脑氧合不足与发育迟缓之间的关联。21.6%的术后患者报告有听力损失，这对认知和语言能力有显著影响。•术后结局的预测因素：血红蛋白饱和度、乳酸水平和血小板计数与术后不良结局在统计学上相关（p<0.05），这强化了术前风险分层的必要性。•快速拔管和资源优化：早期拔管方案使ICU住院时间平均减少20%，术后并发症减少15%。然而，经济激励不足和报销模式不完善限制了它们的广泛采用，尤其是在资源匮乏的环境中。•定制麻醉技术：个性化麻醉策略，包括神经保护方法和血液保护技术，改善了高危CHD人群的结局，并发症发生率降低了10%。•CHD护理的全球差异：来自低收入国家的研究显示，营养不良、手术干预延迟和术后并发症的发生率显著更高。这些差异凸显了全球政策改革以改善CHD管理中医疗公平性的迫切需求。
本评价强调了整合预测分析、多学科方法和医疗系统改革以加强CHD管理的必要性。虽然手术技术和围手术期护理的进步产生了有希望的结果，但持续存在的挑战——包括医疗差异、经济限制和长期神经发育风险——需要有针对性的干预措施。未来的研究应侧重于个性化护理模式、全球卫生政策调整和创新技术，以优化CHD患者的结局。
