Clinical Importance of Concomitant Cleft Lip/Palate in the Surgical Management of Patients With Congenital Heart Disease.
Clinical Importance of Concomitant Cleft Lip/Palate in the Surgical Management of Patients With Congenital Heart Disease.
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DOI：
10.1177/2150135120954814
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发表时间：
2021-01
影响因子：
0.9
通讯作者：
Kumar SR
中科院分区：
文献类型：
--
作者：
Toubat O;Mallios DN;Munabi NCO;Magee WP 3rd;Starnes VA;Kumar SR
先天性心脏病（CHD）经常与心外发育异常（包括裂畸形）一起发生。伴发唇裂对冠心病手术治疗的临床影响尚未有研究。我们评估了合并冠心病和唇腭裂（CL/P）患者的心脏手术结果。纳入了2004年1月至2018年12月期间在我院管理的冠心病+ CL/P患者。回顾性收集人口学、手术和随访资料，并使用SAS 9.4进行分析。分类变量采用卡方检验，连续变量采用t检验或Wilcoxon秩和检验。采用P < 0.05的显著性。冠心病+ CL/P患者127例；63例（50%）为男孩。与普通冠心病人群相比，冠心病+ CL/P患者房间隔缺损（10.5% vs 34%）、法洛四联症/双出口右心室（6.4% vs 15.7%）、弓缺损（4.5% vs 10.2%）、动脉干（1.2% vs 3.1%）和肺静脉总异常回流（1.0% vs 2.4%）增加。在63例接受冠心病修复的患者中，58例（92%）在21.5天（6-114）天大时进行了CL/P修复。与我院接受心脏手术修复的冠心病病变匹配的患者相比，CL/P患者重症监护时间延长2- 3.7倍，住院时间延长1.8- 2.6倍，主要发病率增加6- 13.5倍，死亡率无显著差异。心脏流出道缺陷在CL/P患者中尤为突出。CL/P的存在增加了冠心病手术后护理的复杂性，但对死亡率没有显著影响。
Congenital heart disease (CHD) frequently occurs in conjunction with extracardiac developmental anomalies, including cleft malformations. The clinical impact of concomitant cleft disease on the surgical management of CHD has not been studied. We evaluated cardiac surgical outcomes in patients with concomitant CHD and cleft lip and/or palate (CL/P). Patients with CHD + CL/P managed at our institution between January 2004 and December 2018 were included. Demographic, operative, and follow-up data were retrospectively collected and analyzed using SAS 9.4. Chi-square tests were used for categorical variables and t test or Wilcoxon rank sum tests for continuous variables. Significance of P < .05 was used. There were 127 patients with CHD + CL/P; 63 (50%) were boys. Compared to the general CHD population, patients with CHD + CL/P demonstrated an enrichment of atrial septal defects (10.5% vs 34%), tetralogy of Fallot/double outlet right ventricle (6.4% vs 15.7%), arch defects (4.5% vs 10.2%), truncus arteriosus (1.2% vs 3.1%), and total anomalous pulmonary venous return (1.0% vs 2.4%). Of 63 patients who underwent CHD repair, 58 (92%) did so prior to CL/P repair at 21.5 (6–114) days of age. Compared to CHD lesion-matched patients undergoing cardiac surgical repair at our institution, patients with CL/P had a 2- to 3.7-fold longer intensive care stay, 1.8- to 2.6-fold longer hospital stay, and 6- to 13.5-fold increase in major morbidity, without a significant difference in mortality. Cardiac outflow tract defects are particularly overrepresented in CL/P patients. The presence of CL/P increases the complexity of postoperative care after CHD surgery, without a significant impact on mortality.