Risk factors for life-threatening cavopulmonary thrombosis in patients undergoing bidirectional superior cavopulmonary shunt: An exploratory study
Risk factors for life-threatening cavopulmonary thrombosis in patients undergoing bidirectional superior cavopulmonary shunt: An exploratory study
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DOI：
10.1016/s0002-8703(97)80009-9
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发表时间：
1997-11-01
影响因子：
4.8
通讯作者：
Feltes, TF
中科院分区：
文献类型：
--
作者：
Forbes, TJ;Rosenthal, GL;Feltes, TF
我们观察了6例双向上级腔静脉分流术后出现危及生命的上级腔静脉或肺动脉血栓形成的患者。通过病例对照研究，我们试图确定这种血栓性并发症的围手术期危险因素。回顾了6例腔静脉血栓形成患者和24例对照组患者的病历，以提取潜在危险因素的数据。列联表和单变量logistic回归用于确定各种围手术期参数与腔静脉血栓形成发生之间的相关性。与血栓形成相关的术前变量包括双侧上级腔静脉，比值比：23，p = 0.02，手术时年龄增加（p = 0.05）和女性（比值比：7，p = 0.05）。McGoon比率（相对肺动脉分支直径指数）与血栓形成风险呈负相关（p = 0.08）。平均右心房（p = 0.08）或心室舒张末期（p = 0.05）压力增加2倍与血栓形成风险增加约70%相关。术中主动脉阻断时间延长与血栓形成风险直接相关（p = 0.06）。与血栓形成相关的术后变量包括术后12小时内上级腔静脉压升高（压力升高5 mmHg的比值比大于或等于10，p = 0.02）和心室功能差（优势比：9，p = 0.06）我们得出结论，接受腔静脉分流术的患者的高风险变量包括双侧上级腔静脉，女性，年龄增加、McGoon比率降低、右心房和心室舒张末期压升高（术前）、主动脉阻断时间延长的患者（术中）、上级腔静脉压升高和心室功能差的患者（术后）。
We have observed six patients with life-threatening superior vena caval or pulmonary thrombosis after bidirectional superior cavopulmonary shunt. With the use of a case control study we sought to identify perioperative risk factors for this thrombotic complication. Medical records of six patients with cavopulmonary thrombosis and those of 24 patients in a control group were reviewed to abstract data for potential risk factors. Contingency tables and univariate logistic regression were used to determine associations between various perioperative parameters and occurrence of cavopulmonary thrombosis. Preoperative variables associated with thrombosis included bilateral superior vena cavae, odds ratio: 23, p = 0.02, increased age at surgery (p = 0.05), and female sex (odds ratio: 7, p = 0.05). The McGoon Ratio (index of relative pulmonary artery branch diameter) was inversely related to thrombosis risk (p = 0.08). Two torr increases in mean right atrial (p = 0.08) or ventricular end-diastolic (p = 0.05) pressures were associated with approximately 70% increases in thrombosis risk. Intraoperative prolongation of aortic crossclamp time related directly to thrombosis risk (p = 0.06). Postoperative variables associated with thrombosis included increased superior vena caval pressure within 12 hours after surgery (odds ratio greater than or equal to 10 for 5 torr increase in pressure, p = 0.02) and poor ventricular function (odds ratio: 9, p = 0.06) We conclude that high risk variables for patients undergoing a cavopulmonary shunt include bilateral superior vena cavae, female sex, increasing age, decreased McGoon Ratio, and elevated right atrial and ventricular end-diastolic pressure (before surgery), patients with prolonged aortic cross-clamp time (during surgery), and patients with elevated superior vena caval pressure and poor ventricular function (after surgery).