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Analysis of Risk Factors for Early Mortality in Surgical Shunt Palliation:Time for a Change?

Congenital Heart Disease 2023年第5期18卷 539-550页

作者： François-Xavier Van Vyve Karlien Carbonez jelena hubrechts Geoffroy de Beco Jean ERubay Mona Momeni Thierry Detaille Alain J.Poncelet Department of Cardiovascular and Thoracic Surgery Universitécatholique de Louvain(UCLouvain)-Cliniques Universitaires Saint-LucBrusselsBelgium Department of Pediatric Cardiology Universitécatholique de Louvain(UCLouvain)-Cliniques Universitaires Saint-LucBrusselsBelgium Department of Anesthesiology Universitécatholique de Louvain(UCLouvain)-Cliniques Universitaires Saint-LucBrusselsBelgium Department of Pediatric Intensive Care Universitécatholique de Louvain(UCLouvain)-Cliniques Universitaires Saint-LucBrusselsBelgium

Objectives:Over the last decade,neonatal repair has been advocated for many congenital heart ***,specific subgroups of complex congenital heart disease still require temporary palliation for which both surgical and endovascular techniques are currently *** reviewed our institutional experience with shunt palliation with an emphasis on risk factors for early ***:This is a single-center retrospective study on 175 patients undergoing surgery for central shunt or modified Blalock-Taussig *** data were extracted from a prospectively collected computerized *** identified risk factors for early mortality by uni-and multi-variable *** data were censored at the time of death or shunt take-down ***:Mean age and weight at surgery were 24 days(IQR[7–95])and 3.4 kg(IQR[2.9–4.8]),respectively,with 96 neonates(55%).Most patients had a biventricular heart disease(115 patients,66%),and 51 patients(29.1%)had univentricular heart *** was performed in 129 patients(74%).Cardiopulmonary bypass was used in 23 patients(13%).The median intensive care and overall length of stay were 4 days(IQR[2–9])and 18 days(IQR[13–29]),***-hospital mortality was 8.6%(15/175).By multivariable regression analysis,prematurity(HR 5.6[2.1–14.7]),CPB use(HR 6.7[2.2–18.6]),unplanned<30-day reoperation(HR 3.5[1.2–10])or catheterization(HR 4.5[1.2–16.9])were all significant predictors of early ***:Procedural-related mortality remains high(8.6%)in surgical shunt *** patients with prematurity,low weight at birth,or if the use of cardiopulmonary bypass is contemplated,alternative endovascular techniques of palliation should be considered together with longitudinal follow-up studies.

关键词： Congenital heart disease cyanosis palliation neonates outcome

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