Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type.
Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type.
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DOI：
10.1016/j.jtcvs.2012.01.016
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发表时间：
2012-07
影响因子：
6
通讯作者：
McCrindle, Brian W.
中科院分区：
文献类型：
--
作者：
Tweddell, James S.;Sleeper, Lynn A.;Ohye, Richard G.;Williams, Ismee A.;Mahony, Lynn;Pizarro, Christian;Pemberton, Victoria L.;Frommelt, Peter C.;Bradley, Scott M.;Cnota, James F.;Hirsch, Jennifer;Kirshbom, Paul M.;Li, Jennifer S.;Pike, Nancy;Puchalski, Michael;Ravishankar, Chitra;Jacobs, Jeffrey P.;Laussen, Peter C.;McCrindle, Brian W.
我们试图确定与接受 Norwood 手术的婴儿死亡和心脏移植相关的因素，并确定可能有利于改良 Blalock-Taussig 分流术 (MBTS) 或右心室肺动脉分流术 (RVPAS) 的关联差异。我们使用竞争风险方法来分析非移植死亡、心脏移植和非移植生存。使用参数事件时间建模和引导来识别独立的预测变量。分析了 549 名受试者（随访 2.7±0.9 年）的数据。死亡风险的特点是早期和持续阶段；移植的特点是只有一个恒定的阶段。与死亡相关的早期因素包括较低的社会经济地位（SES；P=.01）、肺静脉回流受阻（P<.001）、升主动脉较小（P=.02）和解剖亚型。与死亡相关的恒定相因素包括遗传综合征（P<.001）和较低胎龄（GA，P<.001）。 51% 的足月主动脉闭锁患者的 RVPAS 具有更好的生存率 (P<.001)。 4% 的主动脉瓣未闭早产儿的 MBTS 较好 (P =.003)。诺伍德手术前较低的右心室面积变化、诺伍德手术前以及左心发育不全综合征以外的解剖结构与移植独立相关（所有 P<.03）；但分流型则不然 (P=.43)。中期死亡率的独立危险因素包括较低的 SES、解剖学、遗传综合征和较低的 GA。患有主动脉闭锁的足月婴儿受益于 RVPAS，而主动脉瓣未闭的早产儿受益于 MBTS。右心室功能和解剖结构与移植相关，但与分流类型无关。
We sought to identify factors associated with death and cardiac transplantation in infants undergoing the Norwood procedure and to determine differences in associations that might favor either the modified Blalock-Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). We used competing risks methodology to analyze death without transplantation, cardiac transplantation, and survival without transplantation. Parametric time-to-event modeling and bootstrapping were used to identify independent predictors. Data from 549 subjects (follow-up, 2.7±0.9 years) were analyzed. Mortality risk was characterized by early and constant phases; transplant was characterized by only a constant phase. Early phase factors associated with death included lower socioeconomic status (SES; P=.01), obstructed pulmonary venous return (P<.001), smaller ascending aorta (P=.02), and anatomic subtype. Constant phase factors associated with death included genetic syndrome (P<.001) and lower gestational age (GA, P<.001). The RVPAS had better survival in the 51% who were full term with aortic atresia (P<.001). The MBTS was better among the 4% who were preterm with a patent aortic valve (P =.003). Lower pre-Norwood right ventricular fractional area change, pre-Norwood surgery, and anatomy other than hypoplastic left heart syndrome were independently associated with transplantation (all P<.03); but shunt type was not (P=.43). Independent risk factors for intermediate-term mortality include lower SES, anatomy, genetic syndrome, and lower GA. Term infants with aortic atresia benefited from a RVPAS and preterm infants with a patent aortic valve benefited from a MBTS. Right ventricular function and anatomy, but not shunt type, were associated with transplantation.
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影响因子：
3.7
作者：
BLACKSTONE, EH;NAFTEL, DC;TURNER, ME
通讯作者：
TURNER, ME
影响因子：
6
作者：
Ashburn, DA;McCrindle, BW;Blackstone, EH
通讯作者：
Blackstone, EH
影响因子：
3.4
作者：
Gaynor, JW;Mahle, WT;Spray, TL
通讯作者：
Spray, TL
DOI：
10.1016/s0735-1097(00)00855-x
发表时间：
2000-10-01
影响因子：
24
作者：
Jenkins, PC;Flanagan, MF;O'Connor, GT
通讯作者：
O'Connor, GT
影响因子：
158.5
作者：
Roux, AVD;Merkin, SS;Watson, RL
通讯作者：
Watson, RL