Risk factors for mortality after the Norwood procedure
Risk factors for mortality after the Norwood procedure
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DOI：
10.1016/s1010-7940(02)00198-7
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发表时间：
2002-07-01
影响因子：
3.4
通讯作者：
Spray, TL
中科院分区：
文献类型：
--
作者：
Gaynor, JW;Mahle, WT;Spray, TL
目的：最近的研究表明，Norwood手术后的存活率受解剖学的影响，对于左心发育不良综合征(HLHS)患者，尤其是主动脉闭锁(AA)患者的存活率更差。与其他形式的功能性单心室和全身流出道梗阻相比。目前的研究是为了评估我们最近使用Norwood手术的经验，并评估潜在的手术死亡率和1年死亡率的预测因素。方法：对1998年1月1日至2001年6月30日期间158例诺伍德手术患者的手术和1年死亡率的危险因素进行了回顾性研究。结果：102例患者(70例AA)存在HLHS，其余56例为其他形式的功能性单心室伴全身流出道梗阻。手术存活率为77%(122/158)，其中HLHS患者为78%，其他诊断患者为75%。多因素分析显示出生体重(OR0.18/kg，95%可信限(CL0.08~0.42，P<；0.001)、合并心脏畸形(OR4.45，95%CL1.50~13.2P=0.001)。总支持时间(OR 1.02/分钟，95%CL 1.01-1.03P=0.004)和体外膜肺氧合或脑室辅助装置支持(OR17.8，95%CL4.40~71.0P<；0.001)作为手术死亡率的预测因素。解剖诊断(HLHS与非HLHS)不是死亡率的预测因素，P=0.6)。1年后Kaplan-Meier生存估计为66%(95%CL 58-73%)，与非HLHS患者相比，HLHS患者没有不同，P=0.5。在Norwood手术中存活的患者1年存活率为86%(95%CL 78-91%)。存在心脏外畸形或遗传综合征(OR 2.70，95%CL 0.98-7.41%，P=0.05)和存在额外的心脏缺陷(OR 3.99)。95%CL1.67~9.57(P=0.002)是第一年生存不良的预测因素。结论：诺伍德手术目前应用于一组不同类型的患者。HLHS患者和其他心脏缺陷患者的手术和1年存活率相当。存在额外的心脏或心脏外异常是预后不良的预测因素。(C)2002 Elsevier Science B.V.保留所有权利。
Objectives: Recent studies have suggested that survival following the Norwood procedure is influenced by anatomy and is worse for patients with hypoplastic left heart syndrome (HLHS), particularly aortic atresia (AA). as compared to other forms of functional single ventricle and systemic outflow tract obstruction. The current study was undertaken to evaluate our recent experience with the Norwood procedure and to evaluate potential predictors of operative and 1-year mortality. Methods: A retrospective study of risk factors for operative and 1-year mortality in 158 patients undergoing the Norwood procedure between January 1, 1998 and June 30, 2001. Results: HLHS was present in 102 patients (70 with AA) and other forms of functional single ventricle with systemic Outflow tract obstruction in the remaining 56. Operative survival was 77% (122/158) 78% for patients with HLHS and 75% for patients with other diagnoses. Multivariable analysis identified birth weight (odds ratio (OR) 0.18/kg 95% confidence limit (CL) 0.08-0.42, P < 0.001), associated cardiac anomalies (OR 4.45, 95% CL 1.50-13.2, P = 0.001). total support time (OR 1.02/min, 95% CL 1.01-1.03. P = 0.004), and extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) support (OR 17.8, 95% CL 4.40-71.0 P < 0.001) as predictors of operative mortality. The anatomic diagnosis (HLHS versus non-HLHS) was not a predictor of mortality, P = 0.6). The Kaplan-Meier survival estimate at 1 year was 66% (95% CL 58-73%) and was not different for patients with HLHS compared to non-HLHS, P = 0.5. For patients who have survived the Norwood procedure, survival to 1 year was 86% (95% CL 78-91%). Presence of an extra-cardiac anomaly or genetic syndrome (OR 2.70, 95% CL 0.98-7.41%, P = 0.05) and presence of an additional cardiac defect (OR 3.99. 95% CL 1.67-9.57, P = 0.002) were predictors of worse survival in the first year of life. Conclusions: The Norwood procedure is currently being applied to a heterogeneous group of patients. Operative and 1-year survival are equivalent for patients with HLHS and those with other cardiac defects. The presence of additional cardiac or extra-cardiac anomalies are predictors of poor outcome. (C) 2002 Elsevier Science B.V. All rights reserved.