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极早产儿的危重型先天性心脏病：来自专业新生儿心脏重症监护病房的手术结果

Critical congenital heart disease in extreme prematurity: Surgical outcomes from a specialized neonatal cardiac intensive care unit.

作者信息

Goldshtrom Nimrod, Vasquez Angelica, Chaves Diana Vargas, Kalfa David, Goldstone Andrew, Cheung Eva, Levasseur Stéphanie, Bacha Emile, Krishnamurthy Ganga

机构信息

Division of Neonatology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.

Department of Surgery, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.

出版信息

JTCVS Open. 2025 Apr 23;25:365-381. doi: 10.1016/j.xjon.2025.04.008. eCollection 2025 Jun.

DOI:10.1016/j.xjon.2025.04.008
PMID:40631003
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12230584/
Abstract

OBJECTIVES

Prematurity is a risk factor for in-hospital mortality after cardiac surgery. Among preterm infants, very preterm (VPT) infants are at the greatest risk of mortality. We evaluated risk factors for in-hospital mortality in VPT infants born at <34 weeks of gestational age with critical congenital heart disease (CHD) who underwent cardiac surgery at our institution.

METHODS

This study is a single-center, retrospective review of VPT infants who underwent cardiac surgical intervention from our dedicated neonatal cardiac care program (Columbia model) between 2006 and 2021. The primary outcome was in-hospital mortality.

RESULTS

A total of 109 subjects met the inclusion criteria. Overall, the in-hospital mortality rate for VPT infants was 16.5% overall, 11% in those with isolated critical CHD, and 34% in those with an identified genetic diagnosis ( = .028). Independent risk factors for mortality included 5-minute Apgar score, cardiopulmonary bypass time, and total number of postoperative complications. Mortality risk also improved over time between 2006 and 2021.

CONCLUSIONS

The Columbia model with its dedicated neonatal cardiac program shows a lower mortality rate in VPT infants compared to the literature. Initiatives that reduce the burden of modifiable risk factors, such as the number of complications, may improve survival in this population.

摘要

目的

早产是心脏手术后院内死亡的一个危险因素。在早产儿中，极早产儿（VPT）的死亡风险最高。我们评估了在我院接受心脏手术的孕龄<34周、患有严重先天性心脏病（CHD）的VPT婴儿院内死亡的危险因素。

方法

本研究是一项单中心回顾性研究，对2006年至2021年间在我们专门的新生儿心脏护理项目（哥伦比亚模式）中接受心脏手术干预的VPT婴儿进行了研究。主要结局是院内死亡。

结果

共有109名受试者符合纳入标准。总体而言，VPT婴儿的院内死亡率为16.5%，单纯严重CHD患儿为11%，有明确基因诊断的患儿为34%（P = 0.028）。死亡的独立危险因素包括5分钟阿氏评分、体外循环时间和术后并发症总数。2006年至2021年间，死亡风险也随着时间的推移而改善。

结论

与文献报道相比，采用专门新生儿心脏项目的哥伦比亚模式显示VPT婴儿死亡率较低。减少可改变危险因素负担的举措，如并发症数量，可能会提高该人群的生存率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/095371b177ee/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/3c679f0f4b80/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/f495f15096ae/fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/9cd2af4b2f75/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/6a5af5f79ace/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/095371b177ee/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/3c679f0f4b80/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/f495f15096ae/fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/9cd2af4b2f75/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/6a5af5f79ace/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8336/12230584/095371b177ee/gr3.jpg

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本文引用的文献

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Double Jeopardy: A Distinct Mortality Pattern Among Preterm Infants with Congenital Heart Disease.双重风险：先天性心脏病早产儿的独特死亡模式
Pediatr Cardiol. 2025 Apr;46(4):939-946. doi: 10.1007/s00246-024-03519-4. Epub 2024 Jun 12.
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Implementation of Rapid Genome Sequencing for Critically Ill Infants With Complex Congenital Heart Disease.对患有复杂先天性心脏病的危重症婴儿实施快速基因组测序
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Neighborhood Deprivation and Association With Neonatal Intensive Care Unit Mortality and Morbidity for Extremely Premature Infants.
社区剥夺与极早产儿新生儿重症监护病房死亡率和发病率的关系。
JAMA Netw Open. 2023 May 1;6(5):e2311761. doi: 10.1001/jamanetworkopen.2023.11761.
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Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults.先天性心脏病流行病学的变化：对成人患者结局及医疗质量的影响
Nat Rev Cardiol. 2023 Feb;20(2):126-137. doi: 10.1038/s41569-022-00749-y. Epub 2022 Aug 31.
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