Knott-Craig C J, Elkins R C, Ramakrishnan K, Hartnett D A, Lane M M, Overholt E D, Ward K E, Razook J R
Section of Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Ann Thorac Surg. 1995 Mar;59(3):573-8. doi: 10.1016/0003-4975(94)01005-6.
Although closure of ventricular septal defects (VSDs) is currently associated with a relatively low risk, infants with associated atrial septal defects (ASDs) seem to have a higher perioperative morbidity. To clarify this impression, we reviewed our entire experience (since 1977) with closure of simple VSDs in 163 infants (age, < or = 12 months). Of these, 57 had significant ASDs (ASD-VSD subgroup). Hospital mortality was 3.7% (6/163) overall and 1.4% (2/145) since 1980. Actuarial survival at 10 years was 92% +/- 5%. Significant morbidity occurred in 15.5% (16/103) of the VSD subgroup versus 48.1% (26/54) of the ASD-VSD subgroup (p < or = 0.001). Multivariate analysis identified the presence of multiple VSDs and early date of operation as risk factors for hospital death, and younger age, an associated ASD, the size of the VSD, and use of hypothermic circulatory arrest as risk factors for significant perioperative morbidity. Compared with the VSD subgroup, the ASD-VSD subgroup had a higher hospital mortality (5.3% [3/57] versus 2.8% [3/106]), were younger (5.1 +/- 2.9 versus 7.2 +/- 2.9 months; p = 0.001), had a higher preoperative pulmonary artery pressure (70.2 +/- 19.0 versus 62.7 +/- 21.8 mm Hg; p = 0.08), needed more inotropic support (12.3% versus 3.7%; p = 0.07), needed more prolonged ventilation (3.3 versus 1.8 days; p = 0.02), and had longer postoperative hospital stays (11 versus 8 days; p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
虽然目前室间隔缺损（VSD）封堵术的风险相对较低，但合并房间隔缺损（ASD）的婴儿围手术期发病率似乎更高。为了明确这一情况，我们回顾了自1977年以来对163例年龄小于或等于12个月的单纯VSD封堵术的全部经验。其中，57例有显著ASD（ASD-VSD亚组）。总体医院死亡率为3.7%（6/163），自1980年以来为1.4%（2/145）。10年的精算生存率为92%±5%。VSD亚组中15.5%（16/103）发生显著并发症，而ASD-VSD亚组为48.1%（26/54）（p≤0.001）。多因素分析确定多个VSD的存在和早期手术日期为医院死亡的危险因素，而年龄较小、合并ASD、VSD大小以及使用低温循环停止为围手术期显著并发症的危险因素。与VSD亚组相比，ASD-VSD亚组医院死亡率更高（5.3%[3/57]对2.8%[3/106]），年龄更小（5.1±2.9对7.2±2.9个月；p = 0.001），术前肺动脉压更高（70.2±19.0对62.7±21.8 mmHg；p = 0.08），需要更多的正性肌力支持（12.3%对3.7%；p = 0.07），需要更长时间的通气（3.3对1.8天；p = 0.02），术后住院时间更长（11对8天；p = 0.005）。（摘要截断于250字）
