Beyens T, Biarent D, Bouton J M, Demanet H, Viart P, Dessy H, Devillé A, Lamote J, Deuvaert F E
Department of Cardiothoracic Surgery, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
Eur J Cardiothorac Surg. 1998 Aug;14(2):165-72. doi: 10.1016/s1010-7940(98)00158-4.
From September 1990 to February 1997, 23 consecutive critically ill infants (12 males, 11 females) weighing 2500 g or less underwent cardiac surgery necessitating extracorporeal circulation (ECC). A retrospective study was carried out to evaluate short- and intermediate-term outcome. Mean weight at operation was 2265 g (range 1750-2500 g). Mean age at operation was 24 days. The indications for surgery were transposition of the great arteries (TGA; 7), ventricular septal defect (VSD; 4), aortic stenosis (AS; 3), univentricular heart (UVH; 2), tetralogy of Fallot (TOF; 2), interrupted aortic arch (IAA; 2), atrial septal defect (ASD; 1), atrioventicular septal defect (AVSD; 1) and total abnormal pulmonary venous return (TAPVR; 1). All patients were in NYHA class IV; 17 patients (74%) were intubated pre-operatively.
The mean aortic cross-clamping time was 40 min. Twelve patients required deep hypothermia (<20 degrees C) with total circulatory arrest (mean duration 19 min). All patients were successfully weaned from extracorporeal circulation (ECC). Five patients left the operating room with an open sternum (mean duration before closure: 3.5 days). Mean duration of artificial ventilation was 10.6 days; of inotropic support 6.7 days and of intensive care stay 17.8 days. Severe complications were observed in 19 patients (83%): cardiac failure requiring high inotropic support (13), sepsis (7), and acute renal insufficiency (5). One patient needed a ventricular assist device. Five patients (22%) died in the intensive care unit (ICU): 2 AS with fibroelastosis, 2 IAA with VSD. and 1 UVH with pulmonary atresia. At discharge from the ICU, 7 patients were receiving no treatment. Mean duration of follow-up was 32 months (range 2-80 months). We had 2 reoperations: 1 for right ventricular outflow tract obstruction 1 year after a switch operation and 1 for mitral valve replacement 1 year after total abnormal pulmonary venous return repair (death 30 days post mitral valve replacement). Survival at I year was 73%. At the last clinical examination 16 patients were in NYHA class I.
Despite the severity of pre-operative cardiac disease, early surgical repair with ECC in infants weighing 2500 g or less is feasible with tolerable mortality yet with significant early morbidity.
1990年9月至1997年2月，连续23例体重2500g及以下的危重症婴儿（男12例，女11例）接受了需要体外循环（ECC）的心脏手术。进行了一项回顾性研究以评估短期和中期结果。手术时的平均体重为2265g（范围1750 - 2500g）。手术时的平均年龄为24天。手术指征包括大动脉转位（TGA；7例）、室间隔缺损（VSD；4例）、主动脉狭窄（AS；3例）、单心室（UVH；2例）、法洛四联症（TOF；2例）、主动脉弓中断（IAA；2例）、房间隔缺损（ASD；1例）、房室间隔缺损（AVSD；1例）和完全性肺静脉异位引流（TAPVR；1例）。所有患者均为纽约心脏协会（NYHA）IV级；17例患者（74%）术前插管。
平均主动脉阻断时间为40分钟。12例患者需要深度低温（<20℃）并完全循环停止（平均持续时间19分钟）。所有患者均成功脱离体外循环（ECC）。5例患者术后胸骨未闭合离开手术室（平均闭合前持续时间：3.5天）。平均人工通气时间为10.6天；使用血管活性药物支持的时间为6.7天，重症监护停留时间为17.8天。19例患者（83%）出现严重并发症：需要高剂量血管活性药物支持的心力衰竭（13例）、败血症（7例）和急性肾功能不全（5例）。1例患者需要心室辅助装置。5例患者（22%）在重症监护病房（ICU）死亡：2例AS合并纤维弹性组织增生，2例IAA合并VSD，1例UVH合并肺动脉闭锁。从ICU出院时，7例患者无需治疗。平均随访时间为32个月（范围2 - 80个月）。我们进行了2次再次手术：1例在调转手术后1年因右心室流出道梗阻进行手术，1例在完全性肺静脉异位引流修复术后1年因二尖瓣置换进行手术（二尖瓣置换术后30天死亡）。1年生存率为73%。在最后一次临床检查时，16例患者为NYHA I级。
尽管术前心脏病严重，但对于体重2500g及以下的婴儿，早期进行体外循环手术修复是可行的，死亡率可耐受，但早期发病率较高。
