Faateh Muhammad, Hogue Spencer, Mehdizadeh-Shrifi Amir, Kulshrestha Kevin, Hossain Md Monir, Lehenbauer David G, Morales David L S, Ashfaq Awais
Division of Cardiovascular Surgery, Department of Surgery, The Heart Institute, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
JTCVS Open. 2024 Oct 26;24:350-358. doi: 10.1016/j.xjon.2024.10.015. eCollection 2025 Apr.
We sought to explore the role of timing on outcomes of the arterial switch operation + ventricular septal defect closure.
Neonates undergoing the arterial switch operation + ventricular septal defect closure from the Pediatric Health Information System database (2004-2022) were identified. Patients with outflow tract obstruction were excluded. Baseline features and outcomes were compared by dividing the cohort by age at the arterial switch operation + ventricular septal defect closure: very early (0-7 days), early (8-14 days), late (15-21 days), and very late (>21 days). A cut-point analysis was performed to identify if an age-cutoff predicted the composite outcome (in-hospital mortality/nonhome discharge/postoperative extracorporeal membrane oxygenation/delayed sternum closure/reoperation due to bleeding).
A total of 1005 patients were identified. The median age at repair was 6 days (interquartile range, 4-9). Repair was performed in the majority of study centers within the patient's first week of life. The distribution was very early in 652 patients (64.9%), early in 247 patients (24.6%), late in 72 patients (7.2%), and very late in 34 patients (3.4%). Late and very late groups had a greater proportion of preterm (6.3% vs 13.8% vs 23.2% vs 26.5%) and low-birthweight (5.8% vs 9% vs 21.9% vs 20%) patients (both < .05). In-hospital mortality was 3.1% and similar among groups ( > .05). The identified cutoff was 8 days. In-hospital mortality was similar when comparing 0 to 8 days with more than 8 days groups (20 [2.8%] vs 11 [3.9%], = .38). The more than 8 days group was more likely to develop the composite outcome (69 [24%] vs 125 [17.4%], = .02), which remained significant in the multivariable analysis (adjusted odds ratio, 1.49; 95% CI, 1.02-2.15; = .04). Hospitalization costs were significantly higher in the more than 8 days group ($240,742 vs $183,728, < .001).
This analysis of more than 1000 neonates born with dextro-transposition of the great arteries + ventricular septal defect without outflow tract obstruction revealed that most patients undergo the arterial switch operation + ventricular septal defect closure within the first week of life and had acceptable major outcomes regardless of timing. Earlier arterial switch operation + ventricular septal defect closure may confer an advantage with regard to secondary outcomes and hospitalization costs.
我们试图探讨手术时机对动脉调转术+室间隔缺损修补术预后的影响。
从儿科健康信息系统数据库（2004 - 2022年）中确定接受动脉调转术+室间隔缺损修补术的新生儿。排除有流出道梗阻的患者。根据动脉调转术+室间隔缺损修补术时的年龄将队列分为：极早期（0 - 7天）、早期（8 - 14天）、晚期（15 - 21天）和极晚期（>21天），比较基线特征和预后。进行切点分析以确定年龄切点是否可预测复合结局（住院死亡率/非回家出院/术后体外膜肺氧合/延迟胸骨闭合/因出血再次手术）。
共确定1005例患者。修复时的中位年龄为6天（四分位间距，4 - 9天）。大多数研究中心在患者出生后第一周内进行修复。分布情况为：极早期652例（64.9%）、早期247例（24.6%）、晚期72例（7.2%）、极晚期34例（3.4%）。晚期和极晚期组早产（6.3%对13.8%对23.2%对26.5%）和低出生体重（5.8%对9%对21.9%对20%）患者的比例更高（均P<0.05）。住院死亡率为3.1%，各组间相似（P>0.05）。确定的切点为8天。比较0至8天组和超过8天组时，住院死亡率相似（20例[2.8%]对11例[3.9%]，P = 0.38）。超过8天组更易出现复合结局（69例[24%]对125例[17.4%]，P = 0.02），在多变量分析中仍具有显著性（调整优势比，1.49；95%置信区间，1.02 - 2.15；P = 0.04）。超过8天组的住院费用显著更高（240,742美元对183,728美元，P<0.001）。
对1000多名患有大动脉右转位+室间隔缺损且无流出道梗阻的新生儿进行的这项分析表明，大多数患者在出生后第一周内接受动脉调转术+室间隔缺损修补术，无论手术时机如何，主要预后均可接受。更早进行动脉调转术+室间隔缺损修补术在次要结局和住院费用方面可能具有优势。
