Predictors of Survival After Single-Ventricle Palliation The Impact of Right Ventricular Dominance
Predictors of Survival After Single-Ventricle Palliation The Impact of Right Ventricular Dominance
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DOI：
10.1016/j.jacc.2011.11.049
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发表时间：
2012-03-27
影响因子：
24
通讯作者：
Brizard, Christian P.
中科院分区：
文献类型：
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作者：
d'Udekem, Yves;Xu, Mary Y.;Brizard, Christian P.
目的研究单心室生理性患儿接受手术姑息治疗后的存活率。背景：目前，所有接受单心室姑息治疗的新生儿的手术结果尚不清楚。方法对1990-2008年间连续499例接受单心室姑息治疗的新生儿进行单中心回顾，通过多因素风险分析确定死亡率的预测因素，并对每个术后停留和中期状态进行分层。结果2000年后，受试者中右室占优势的患者(66%比36%)和左心发育不良综合征(HLHS)的患者(47%比13%)更多。双向腔肺分流术(BCPS)的中位年龄从2000年前的15个月(10~22个月)下降到4个月(3.3~9个月)。1、5、10年生存率分别为82%(95%可信区间：79%~85%)、74%(95%可信区间：70%~78%)和71%(95%可信区间：67%~75%)。在整个研究过程中，房室瓣反流(风险比：1.8；p=0.008)、没有转位(HR：2.0；p=0.013)和异位(HR：2.0；p=0.026)是死亡率的预测因素。最大的危险因素是右室优势(HR：2.2；p=0.001)，因为它在BCP前有影响。RV占优势的患者的死亡比率从BCPS前的2.8(95%CI：1.4~5.7；p=0.005)降至1.0(95%CI：0.5~2.1；p=0.98)。经上述危险因素调整后，右室占优势的患者的存活率在研究期间有所改善(p=0.001)。结论单心室患者在出生后的头几年仍有相当大的死亡率。RV优势是最重要的死亡危险因素，但仅限于BCPS之前。(J Am Coll心脏ol 2012；59：1178-85)(C)2012，美国心脏病学会基金会
Objectives This study examined survival after surgical palliation in children with single-ventricle physiology.Background Contemporary surgical outcomes for the entire population of newborns undergoing single-ventricle palliation are unclear.Methods In a single-center review of 499 consecutive patients undergoing univentricular palliation from 1990 to 2008, predictors of mortality were determined using multivariate risk analysis, stratified for each post-operative stay and interim states.Results After 2000, the population comprised more patients with dominant right ventricle (66% vs. 36%) and hypoplastic left heart syndrome (HLHS) (47% vs. 13%). Median age at bidirectional cavopulmonary shunt (BCPS) decreased from 15 months (10 to 22 months) before 2000 to 4 months (3.3 to 9 months) thereafter. Survival rates at 1, 5, and 10 years were, respectively, 82% (95% confidence interval [CI]: 79% to 85%), 74% (95% CI: 70% to 78%), and 71% (95% CI: 67% to 75%). Throughout the study, atrioventricular valve regurgitation (hazard ratio [HR]: 1.8; p = 0.008), not having transposition (HR: 2.0; p = 0.013), and heterotaxia (HR: 2.0; p = 0.026) were predictors of mortality. The most potent risk factor was right ventricular (RV) dominance (HR: 2.2; p = 0.001) because of its impact before BCPS. HR for death in patients with RV dominance went from 2.8 (95% CI: 1.4 to 5.7; p = 0.005) before BCPS to 1.0 (95% CI: 0.5 to 2.1; p = 0.98) thereafter. Survival of patients with RV dominance, adjusted for the risk factors noted here, improved over the study period (p = 0.001).Conclusions Considerable mortality is still observed during the first years of life among patients with single ventricle. RV dominance is the most important risk factor for death but only before BCPS. (J Am Coll Cardiol 2012; 59: 1178-85) (C) 2012 by the American College of Cardiology Foundation