Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
复制标题
DOI：
10.1016/j.jtcvs.2013.09.075
复制
发表时间：
2014-02
影响因子：
6
通讯作者：
Pasquali, Sara K.
中科院分区：
文献类型：
--
作者：
Mascio, Christopher E.;Austin, Erle H., III;Jacobs, Jeffrey P.;Jacobs, Marshall L.;Wallace, Amelia S.;He, Xia;Pasquali, Sara K.
儿科心脏手术中机械循环支持（MCS）的分析主要集中在单中心结局或狭窄应用。我们描述了一个大型多中心队列的使用模式、患者特征和MCS相关结局。纳入STS先天性心脏手术数据库（2000-2010）中的患者（<18岁）。描述了接受术后MCS的患者的特征和结局，并使用贝叶斯分层模型来检查各机构调整后MCS率的变化。在96，596例手术（80个中心）中，MCS的使用率为2.4%。MCS患者更年轻（13天vs. 195天，p<0.0001），更常见STS定义的术前风险因素（57.2% vs. 32.7%，p<0.0001）。MCS发生率最高的手术包括诺伍德手术（17%）和复杂的双心室修复术（动脉转位/VSD/弓修复术-14%）。超过一半的MCS患者（53.2%）未能存活至出院（与2.9%的非MCS患者相比，p<0.0001）。动脉干和Ross-Konno手术的MCS相关死亡率最高（均为71%）。根据患者特征和病例组合调整的医院级MCS发生率在各机构之间变化15倍;高容量和低容量医院的MCS发生率差异很大。各中心的围手术期MCS使用情况差异很大。总体而言，诺伍德手术和复杂双心室修复术的MCS发生率最高。虽然MCS可以是一种挽救生命的疗法，但超过一半的MCS患者无法存活到出院，某些手术的死亡率>70%。未来的研究旨在更好地了解MCS的适当适应症、最佳时机和管理，这可能有助于减少各医院MCS的差异并改善结局。
Analyses of mechanical circulatory support (MCS) in pediatric heart surgery have primarily focused on single-center outcomes or narrow applications. We describe patterns of use, patient characteristics, and MCS-associated outcomes across a large multicenter cohort. Patients (<18yrs) in the STS Congenital Heart Surgery Database (2000-2010) were included. Characteristics and outcomes of those receiving post-operative MCS were described, and Bayesian hierarchical models were used to examine variation in adjusted MCS rates across institutions. Of 96,596 operations (80 centers), MCS was used in 2.4%. MCS patients were younger (13d v. 195d, p<0.0001) and more often had STS-defined preoperative risk factors (57.2% v. 32.7%, p<0.0001). Operations with the highest MCS rates included the Norwood procedure (17%) and complex biventricular repairs (arterial switch/VSD/arch repair-14%). Over half of MCS patients (53.2%) did not survive to hospital discharge (vs. 2.9%, non-MCS patients, p<0.0001). MCS-associated mortality was highest for truncus arteriosus and Ross-Konno operations (both 71%). Hospital-level MCS rates adjusted for patient characteristics and case mix varied by 15-fold across institutions; both high and low volume hospitals had substantial variation in MCS rates. Perioperative MCS use varies widely across centers. MCS rates are highest overall for the Norwood procedure and complex biventricular repairs. Although MCS can be a life-saving therapy, over half of MCS patients do not survive to hospital discharge with mortality >70% for some operations. Future studies aimed at better understanding appropriate indications, optimal timing, and management of MCS may help to reduce variation in MCS across hospitals and improve outcomes.
登录
查看更多内容
影响因子：
4.2
作者：
Conrad, SA;Rycus, PT;Dalton, H
通讯作者：
Dalton, H
影响因子：
37.8
作者：
Almond, Christopher S.;Singh, Tajinder P.;Thiagarajan, Ravi R.
通讯作者：
Thiagarajan, Ravi R.
影响因子：
3.4
作者：
Dimick, Justin B.;Staiger, Douglas O.;Birkmeyer, John D.
通讯作者：
Birkmeyer, John D.
影响因子：
4.6
作者：
Jacobs, Marshall L.;Mavroudis, Constantine;Pelletier, Glenn J.
通讯作者：
Pelletier, Glenn J.
DOI：
10.1177/2150135111426732
发表时间：
2012-01-01
影响因子：
0.9
作者：
Jacobs, Jeffrey Phillip;Jacobs, Marshall Lewis;Mayer, John E., Jr.
通讯作者：
Mayer, John E., Jr.