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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]),unplannedmonary 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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Analysis of Pulmonary Arteries Growth after Initial Shunt Palliation in Neonates and Infants

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Congenital Heart Disease 2023年第5期18卷 525-537页

作者： François-Xavier Van Vyve Karlien Carbonez Geoffroy de Beco Stéphane Moniotte Jean ERubay mona momeni Laurent Houtekie Alain J.Poncelet Department of Cardiovascular and Thoracic Surgery Universitécatholique de Louvain(UCLouvain)—Cliniques Universitaires Saint-LucBrusselsB-1200Belgium Department of Pediatric Cardiology Universitécatholique de Louvain(UCLouvain)—Cliniques Universitaires Saint-LucBrusselsB-1200Belgium Department of Anesthesiology Universitécatholique de Louvain(UCLouvain)—Cliniques Universitaires Saint-LucBrusselsB-1200Belgium Department of Pediatric Intensive Care Universitécatholique de Louvain(UCLouvain)—Cliniques Universitaires Saint-LucBrusselsB-1200Belgium

Objective:Despite increasing enthusiasm for neonatal repair,patients with ductal-dependent circulation(pulmonary/systemic)or restrictive pulmonary blood flow still require initial *** stenting has emerged as an endovascular approach whereas modified-Blalock-Taussig and central shunt remain surgical *** this study,we analyzed the relationship between pulmonary artery growth,sites of shunt connection,or antegrade pulmonary blood flow in surgically placed *** need for secondary catheter-based interventions or pulmonary arterioplasty was also ***:A retrospective single-center study analyzing 175 patients undergoing surgery for a central or modified-Blalock-Taussig *** growth variables were right pulmonary artery/left pulmonary artery diameters/Z scores,the indexed sum area(right pulmonary artery+left pulmonary artery),and the pulmonary symmetry *** imaging modalities were used:angiography,computed tomography,and ***:At baseline,pulmonary arteries were larger in patients with antegrade pulmonary blood flow(Nakata index 137 vs.114,p=0.047)as well as in patients receiving a modified-Blalock-Taussig shunt(Nakata index 138 vs.84,pmonary artery and left pulmonary artery had normalized their *** Nakata index increased from 134 to 233 mm^(2)/m^(2)(pmonary artery index remained stable(0.86)over *** the inter-stage period,shunt-related pulmonary artery stenosis and juxta-ductal stenosis were diagnosed in 16(10%)and 17 patients(11%),***:Surgical shunt palliation allows normal pulmonary artery *** artery stenosis was either shunt-related(10%)or secondary to juxta-ductal stenosis(11%).Close echographic follow-up allows early diagnosis and treatment of juxta-ductal stenosis.

关键词： Congenital heart disease cyanosis palliation neonates outcome

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Cardiac Surgery with Cardiopulmonary Bypass in Low-Weight or Preterm Neonates:A Retrospective Study Analyzing Early Outcome

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Congenital Heart Disease 2023年第2期18卷 151-168页

作者： Alain J.Poncelet Maureen Peers de Nieuwburgh Stéphane Moniotte Geoffroy de Beco Karlien Carbonez Jean E.Rubay Thierry Detaille Laurent Houtekie mona momeni Department of Cardiovascular and Thoracic Surgery Universitécatholique de LouvainCliniques Universitaires Saint-LucBrusselsBelgium Department of Pediatric Cardiology Universitécatholique de LouvainCliniques Universitaires Saint-LucBrusselsBelgium Department of Pediatric Intensive Care Universitécatholique de LouvainCliniques Universitaires Saint-LucBrusselsBelgium Department of Anesthesiology Universitécatholique de LouvainCliniques Universitaires Saint-LucBrusselsBelgium

Background:Most outcome studies in congenital cardiac surgery for“low weight”neonates include patients undergoing surgery without cardiopulmonary bypass(CPB).The primary objective of our study was to identify risk factors for in-hospital mortality in neonates weighing less than 3 Kg and undergoing surgery with *** addition,we compared the effect of early surgery with CPB(before 37W-gestational age(GA))for congenital heart disease to delayed surgery until a corrected GA of 37 weeks in an attempt to promote weight ***:Retrospective single-center study including all patients operated between 1997 and ***-and multivariable analysis were used to analyze ***:143 patients were *** median weight was 2.7 Kg and 49(34.3%)weighted<2.5 Kg.80%of the patients were Risk stratification STAT categories≥3.114 patients(80%)were operated without delay(usual timing,median age 9 days),whereas 29 patients(20%)entered a delayed strategy(median age 30 days).In-hospital mortality was 21.7%.By multivariate analysis,dysmaturity,preoperative positive ventilation,post-operative ECMO requirement or resuscitation,and any residual lesion were predictors of in-hospital ***-hospital mortality in the usual timing group and the delayed group were 21.1%and 24.1%,respectively(p=0.71).In-hospital mortality for neonates operated prior to 37W-GA(n=10)was 27.3%.Conclusions:Predictors of in-hospital mortality in neonates less 3 Kg requiring CPB surgery did not differ from those unveiled in other contemporary *** data demonstrates that a strategy of delaying surgery in selected patients resulted in similar clinical outcome.

关键词： Congenital heart disease neonate perioperative care morbidity and survival

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