美国心血管外科医师协会关于成人先心病诊治疗效的报道

2012-1-22 08:41| 发布者: 陆医生| 查看: 247| 评论: 0

Outcomes in Adult Congenital Heart Surgery: Analysis of the ...

J Thorac Cardiovasc Surg 2011;142:1090-1097
© 2011 The American Association for Thoracic Surgery

Congenital Heart Disease

Outcomes in adult congenital heart surgery: Analysis of the Society of Thoracic Surgeons Database

Christopher E. Mascio, MD^a^,_*, Sara K. Pasquali, MD^b, Jeffrey P. Jacobs, MD^c, Marshall L. Jacobs, MD^d, Erle H. Austin, III, MD^a

^a Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, Louisville, Ky
^b Division of Cardiology, Department of Pediatrics, Duke University Medical Center, and Duke Clinical Research Institute, Durham, NC
^c Division of Thoracic and Cardiovascular Surgery, The Congenital Heart Institute of Florida, All Children’s Hospital, University of South Florida College of Medicine, Saint Petersburg and Tampa, Fla
^d Department of Pediatric and Congenital Heart Surgery, Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic Foundation, Cleveland, Ohio

Read at the 91st Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pennsylvania, May 7-11, 2011.

Received for publication May 5, 2011; revisions received July 11, 2011; accepted for publication July 19, 2011.

^_* Address for reprints: Christopher E. Mascio, MD, 201 Abraham Flexner Way-Suite 1200, Louisville, KY 40202. (Email: cmascio@louisvilleheartsurgery.com).

Objective: Outcomes data for adults undergoing congenital heart surgery are limited. Previous analyses used administrative data or focused on single-center outcomes. We describe the most common operations, patient characteristics, and postoperative outcomes using a multicenter clinical database.

Methods: The study included adults (aged $≥$ 18 years) listed in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2000–2009). We describe patient characteristics and morbidity and mortality, and examine congenital procedures in the Society of Thoracic Surgeons Adult Cardiac Surgery Database to permit consideration of the primary dataset within a broader context.

Results: A total of 5265 patients (68 centers) from the Society of Thoracic Surgeons Congenital Heart Surgery Database were included. Patients’ median age was 25 years (interquartile range, 20–35). Common preoperative risk factors included noncardiac abnormalities (17%) and arrhythmia (14%). Overall, in-hospital mortality was 2.1%, 27% had 1 or more complication, and median length of stay was 5 days. Common operations included right ventricular outflow tract procedures (21%) and pacemaker/arrhythmia procedures (20%). We further evaluated cardiopulmonary bypass procedures in more than 100 patients. Mortality ranged from 0% (atrial septal defect repair) to 11% (Fontan revision/conversion). Separate evaluation of the Society of Thoracic Surgeons Adult Cardiac Surgery Database revealed 39,872 adults undergoing congenital heart operations.

Conclusions: Most adult congenital heart operations listed in the Society of Thoracic Surgeons Congenital Heart Surgery Database are performed in the third to fourth decades of life; approximately half are for right heart pathology or arrhythmia. Many patients have complications, but mortality is low with the exception of those undergoing Fontan revision/conversion. Many more adults undergoing congenital heart surgery are entered into the Society of Thoracic Surgeons Adult Cardiac Surgery Database.

结论：大多数成人先心病患者都在三四十岁左右进行手术，以右心系统畸形和心律失常为主。很多病人都会伴有不良并发症，除了Fontan二期管道置换手术之外，整体死亡率还是很低的。

Table 3. Outcomes

	Overall (n = 5265)	Pulmonary valve replacement (n = 574)	ASD repair (n = 365)	Conduit operation (n = 328)	Aortic aneurysm repair (n = 136)	Mitral valvuloplasty (n = 135)	Ross operation (n = 108)	Fontan revision/conversion (n = 105)
In-hospital mortality	109 (2.1%)	4 (0.7%)	0 (0%)	8 (2.4%)	3 (2.2%)	1 (0.7%)	2 (1.9%)	11 (11%)
Length of stay (d)	5 [3–7]	5 [4–6]	4 [3–5]	5 [4–7]	6 [4–8]	5 [4–8]	5 [4–6]	10 [7–13]
Postoperative complication
Any	1446 (28%)	135 (24%)	72 (20%)	96 (29%)	35 (26%)	48 (36%)	43 (40%)	54 (51%)
Arrhythmia	496 (9.4%)	39 (6.8%)	28 (7.7%)	26 (7.9%)	8 (5.9%)	22 (16%)	11 (10%)	24 (23%)
Low cardiac output	87 (1.7%)	4 (0.7%)	3 (0.8%)	5 (1.5%)	2 (1.5%)	4 (3.0%)	4 (3.7%)	9 (8.6%)
AV block requiring permanent pacer	69 (1.3%)	0 (0%)	0 (0%)	1 (0.3%)	3 (2.2%)	1 (0.7%)	2 (1.9%)	1 (1.0%)
Cardiac arrest	52 (1.0%)	2 (0.4%)	0 (0%)	7 (2.1%)	3 (2.2%)	1 (0.7%)	0 (0%)	3 (2.9%)
Pleural effusion	162 (3.1%)	6 (1.1%)	6 (1.6%)	12 (3.7%)	4 (2.9%)	11 (8.2%)	4 (3.7%)	7 (6.7%)
Pneumonia	124 (2.4%)	19 (3.3%)	12 (3.3%)	3 (0.9%)	0 (0%)	0 (0%)	0 (0%)	1 (1.0%)
Reintubation	71 (1.4%)	1 (0.2%)	1 (0.3%)	8 (2.4%)	1 (0.7%)	2 (1.5%)	1 (0.9%)	6 (5.7%)
Mechanical ventilation > 7 d	52 (1.0%)	0 (0%)	2 (0.6%)	7 (2.1%)	1 (0.7%)	0 (0%)	0 (0%)	6 (5.7%)
Unplanned reoperation	111 (2.1%)	4 (0.7%)	2 (0.6%)	6 (1.8%)	4 (2.9%)	3 (2.2%)	1 (0.9%)	5 (4.8%)
Bleeding requiring reoperation	100 (1.9%)	7 (1.2%)	2 (0.6%)	6 (1.8%)	4 (2.9%)	1 (0.7%)	9 (8.3%)	4 (3.8%)
Renal failure requiring temporary dialysis	56 (1.1%)	3 (0.5%)	0 (0%)	4 (1.2%)	0 (0%)	0 (0%)	0 (0%)	9 (8.6%)

Continuous variables are presented as median [IQR]. Postoperative complications occurring in more than 1.0% of the study population are shown. ASD, Atrial septal defect; AV, atrioventricular.