Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia
Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia
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DOI：
10.1067/mtc.2003.183
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发表时间：
2003-05-01
影响因子：
6
通讯作者：
Blackstone, EH
中科院分区：
文献类型：
--
作者：
Ashburn, DA;McCrindle, BW;Blackstone, EH
目的：本研究旨在确定人口统计学、解剖学、机构和手术风险因素与诺伍德手术后结局的相关性。方法：在1994年至2000年的前瞻性29家机构研究中，985例危重主动脉瓣狭窄或闭锁新生儿中共有710例接受了诺伍德手术。对64%的新生儿入院超声心动图进行了独立审查。对诺伍德手术后和腔静脉分流术后的结局进行竞争风险分析。结果：诺伍德手术后1个月、1年和5年的总生存率分别为72%、60%和54%。根据竞争风险分析，97%的新生儿在诺伍德手术后18个月达到后续过渡状态，包括死亡（37%）、腔静脉分流（58%）或其他状态（2%，心脏移植、双心室修复或Fontan手术）。在随后的过渡前发生死亡的风险因素包括患者特异性变量（出生体重较低、升主动脉较小、诺伍德手术时年龄较大）、机构变量（机构入组：510名新生儿，2个机构入组：40名新生儿）和手术变量（源自主动脉的分流、循环停搏时间较长和升主动脉的管理）。在接受腔静脉分流术的新生儿中，91%在腔静脉分流术后6年达到了随后的过渡状态，包括Fontan手术（79%）、死亡（9%）或心脏移植（3%）。死亡的危险因素发生在随后的过渡包括年龄较小的腔静脉分流和右房室瓣repair.Conclusions的需要：竞争风险分析定义的患病率的各种结果后，诺伍德手术和预测改善的结果与成功的修改可控的风险因素。
Objective: This study was undertaken to determine the demographic, anatomic, institutional, and surgical risk factors associated with outcomes after the Norwood operation.Methods: A total of 710 of 985 neonates with critical aortic stenosis or atresia enrolled in a prospective 29-institution study between 1994 and 2000 underwent the Norwood operation. Admission echocardiograms were independently reviewed for 64% of neonates. Competing risks analyses were constructed for outcomes after Norwood operation and after cavopulmonary shunt. Incremental risk factors for outcome events were sought.Results: Overall survivals after the Norwood operation were 72%, 60%, and 54% at 1 month, 1 year, and 5 years, respectively. According to competing risks analysis, 97% of neonates reached a subsequent transition state by 18 months after Norwood operation, consisting of death (37%), cavopulmonary shunt (58%), or other state (2%, cardiac transplantation, biventricular repair, or Fontan operation). Risk factors for death occurring before subsequent transition included patient-specific variables (lower birth weight, smaller ascending aorta, older age at Norwood operation), institutional variables (institutions enrolling :510 neonates, two institutions enrolling :40 neonates), and procedural variables (shunt originating from aorta, longer circulatory arrest time, and management of the ascending aorta). Of neonates undergoing cavopulmonary shunt, 91% had reached a subsequent transition state by 6 years after cavopulmonary shunt, consisting of Fontan operation (79%), death (9%), or cardiac transplantation (3%). Risk factors for death occurring before subsequent transition included younger age at cavopulmonary shunt and need for right atrioventricular valve repair.Conclusions: Competing risks analysis defines the prevalence of the various outcomes after Norwood operation and predicts improved outcomes with successful modification of controllable risk factors.