Risk Factors for Perioperative Brain Lesions in Infants With Congenital Heart Disease: A European Collaboration.
Risk Factors for Perioperative Brain Lesions in Infants With Congenital Heart Disease: A European Collaboration.
复制标题
DOI：
10.1161/strokeaha.122.039492
复制
发表时间：
2022-12
期刊：
影响因子：
8.3
通讯作者：
Breur, Johannes M. P. J.
中科院分区：
文献类型：
--
作者：
Bonthrone, Alexandra F.;Stegeman, Raymond;Feldmann, Maria;Claessens, Nathalie H. P.;Nijman, Maaike;Jansen, Nicolaas J. G.;Nijman, Joppe;Groenendaal, Floris;de Vries, Linda S.;Benders, Manon J. N. L.;Haas, Felix;Bekker, Mirielle N.;Logeswaran, Thushiha;Reich, Bettina;Kottke, Raimund;Hagmann, Cornelia;Latal, Beatrice;Dave, Hitendu;Simpson, John;Pushparajah, Kuberan;Austin, Conal;Kelly, Christopher J.;Arulkumaran, Sophie;Rutherford, Mary A.;Counsell, Serena J.;Knirsch, Walter;Breur, Johannes M. P. J.
关键词：
患有先天性心脏病的婴儿有脑损伤和神经发育受损的风险。目的是调查先天性心脏病婴儿围手术期脑损伤的危险因素。合并了来自3个欧洲队列（乌得勒支、苏黎世和伦敦）的出生后<6周接受心脏手术的大动脉转位、单心室生理学和左心室流出道和/或主动脉弓梗阻的婴儿。术前对脑部病变进行评分，（大动脉转位N = 104;单心室生理学N = 35;左心室流出道和/或主动脉弓梗阻N = 41）和术后（大动脉转位N = 88;单心室生理学N = 28;和左心室流出道和/或主动脉弓阻塞N = 30）磁共振成像用于动脉缺血性卒中，脑静脉窦血栓形成，和白色物质损伤。术前，阴道引产（比值比[OR]，2.23 [95% CI，1.06 - 4.70]）与白色损伤相关，球囊房间隔造口术增加了白色损伤（OR，2.51 [95% CI，1.23 - 5.20]）和动脉缺血性卒中（OR，4.49 [95% CI，1.20 - 21.49]）的风险。术后，手术时出生后年龄较小（OR，1.18 [95% CI，1.05 - 1.33]）和选择性脑灌注，特别是在≤ 20 ° C（OR，13.46 [95% CI，3.58 - 67.10]）下，与新发动脉缺血性卒中相关。单心室生理学与新发白色损伤（OR，2.88 [95% CI，1.20 - 6.95]）和大动脉转位伴新发脑静脉窦血栓形成（OR，13.47 [95% CI，2.28 - 95.66]）相关。延迟胸骨闭合（OR，3.47 [95% CI，1.08 - 13.06]）和术中温度较低（OR，1.22 [95% CI，1.07 - 1.36]）也增加了新发脑静脉窦血栓形成的风险。分娩计划和手术时机可能是可改变的风险因素，允许个性化治疗，以尽量减少严重先天性心脏病围手术期脑损伤的风险。需要进一步的研究来优化新生儿手术的脑灌注技术，并确认脑静脉窦血栓形成与围手术期危险因素之间的关系。
Infants with congenital heart disease are at risk of brain injury and impaired neurodevelopment. The aim was to investigate risk factors for perioperative brain lesions in infants with congenital heart disease. Infants with transposition of the great arteries, single ventricle physiology, and left ventricular outflow tract and/or aortic arch obstruction undergoing cardiac surgery <6 weeks after birth from 3 European cohorts (Utrecht, Zurich, and London) were combined. Brain lesions were scored on preoperative (transposition of the great arteries N=104; single ventricle physiology N=35; and left ventricular outflow tract and/or aortic arch obstruction N=41) and postoperative (transposition of the great arteries N=88; single ventricle physiology N=28; and left ventricular outflow tract and/or aortic arch obstruction N=30) magnetic resonance imaging for risk factor analysis of arterial ischemic stroke, cerebral sinus venous thrombosis, and white matter injury. Preoperatively, induced vaginal delivery (odds ratio [OR], 2.23 [95% CI, 1.06–4.70]) was associated with white matter injury and balloon atrial septostomy increased the risk of white matter injury (OR, 2.51 [95% CI, 1.23–5.20]) and arterial ischemic stroke (OR, 4.49 [95% CI, 1.20–21.49]). Postoperatively, younger postnatal age at surgery (OR, 1.18 [95% CI, 1.05–1.33]) and selective cerebral perfusion, particularly at ≤20 °C (OR, 13.46 [95% CI, 3.58–67.10]), were associated with new arterial ischemic stroke. Single ventricle physiology was associated with new white matter injury (OR, 2.88 [95% CI, 1.20–6.95]) and transposition of the great arteries with new cerebral sinus venous thrombosis (OR, 13.47 [95% CI, 2.28–95.66]). Delayed sternal closure (OR, 3.47 [95% CI, 1.08–13.06]) and lower intraoperative temperatures (OR, 1.22 [95% CI, 1.07–1.36]) also increased the risk of new cerebral sinus venous thrombosis. Delivery planning and surgery timing may be modifiable risk factors that allow personalized treatment to minimize the risk of perioperative brain injury in severe congenital heart disease. Further research is needed to optimize cerebral perfusion techniques for neonatal surgery and to confirm the relationship between cerebral sinus venous thrombosis and perioperative risk factors.