Effect of preoperative duration of mechanical ventilation on prognosis in patients with ventricular septal defect: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Juemin ^1,2 , REN Qiushi ^1,2 , CHEN Tianyu ² , QIU Hailong ² , LIU Xiaobing ² ,  ZHUANG Jian ²

1. School of Medicine, South China University of Technology, Guangzhou, 511400, P. R. China;
2. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@163.com

Keywords：

Congenital heart disease; ventricular septal defect; ventilator support; prognosis

DOI：

10.7507/1007-4848.202208025

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the relationship between preoperative duration of mechanical ventilation and prognosis in patients with ventricular septal defect. Methods The clinical data of patients with ventricular septal defect requiring ventilator support preoperatively and undergoing surgical treatment in our hospital from May 2009 to May 2020 were retrospectively reviewed. Based on the duration of preoperative ventilation, the patients were divided into three groups: a group A (0-47 hours), a group B (48-96 hours), and a group C (＞96 hours). Each group's postoperative recovery, complications, and medical costs were analyzed. Results Finally 272 patients were enrolled, including 154 males and 118 females, with a median surgical age of 2 (1, 4) months. There were 43 patients in the group A, 75 patients in the group B, and 154 patients in the group C. Early death occured in 3 (1.3%) patients, all in the group C. No statistical difference in mortality was found among the three groups (P=0.734). The mean postoperative duration of mechanical ventilation in the three groups was 158.6±133.5 hours, 101.2±56.1 hours, and 133.1±97.9 hours, respectively. The group B had significantly shorter duration than the other two groups (P＜0.05). The mean postoperative hospital stay in the three groups was 17.5±9.9 days, 13.5±5.8 days, and 16.5±10.8 days, respectively. Postoperative hospital stay in the group B was significantly shorter than that in the other two groups (P＜0.05). The mean total in-hospital cost in the three groups were 89 000±34 000 yuan, 87 000±21 000 yuan, and 109 000±41 000 yuan, respectively. The costs in the group C were significantly higher than those in the other two groups (P≤0.001). Conclusion Prompt surgical repair is necessary for patients with ventricular septal defects requiring ventilator support preoperatively. However, attention should be paid to surgical timing. Preoperative duration of mechanical ventilation is associated with better surgical outcomes within 48-96 hours than 0-47 hours or ＞96 hours.

Citation： YU Juemin, REN Qiushi, CHEN Tianyu, QIU Hailong, LIU Xiaobing, ZHUANG Jian. Effect of preoperative duration of mechanical ventilation on prognosis in patients with ventricular septal defect: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 1025-1029. doi: 10.7507/1007-4848.202208025 Copy

1.	Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2.	Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: The current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
3.	Vaidyanathan B, Roth SJ, Rao SG, et al. Outcome of ventricular septal defect repair in a developing country. J Pediatr, 2002, 140(6): 736-741.
4.	Zhang W, Hu R, Zhu Y, et al. Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation. J Thorac Cardiovasc Surg, 2020, 159(5): 1945-1952.
5.	Jacobs JP, O'Brien SM, Pasquali SK, et al. The importance of patient-specific preoperative factors: An analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg, 2014, 98(5): 1653-1658.
6.	Hornik CP, He X, Jacobs JP, et al. Complications after the Norwood operation: An analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg, 2011, 92(5): 1734-1740.
7.	Brown KL, Ridout DA, Goldman AP, et al. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med, 2003, 31(1): 28-33.
8.	Ciociola EC, Kumar KR, Zimmerman KO, et al. Association between preoperative respiratory support and outcomes in paediatric cardiac surgery. Cardiol Young, 2020, 30(1): 66-73.
9.	Jacobs JP, Jacobs ML, Austin EH, et al. Quality measures for congenital and pediatric cardiac surgery. World J Pediatr Congenit Heart Surg, 2012, 3(1): 32-47.
10.	Bhatt M, Roth SJ, Kumar RK, et al. Management of infants with large, unrepaired ventricular septal defects and respiratory infection requiring mechanical ventilation. J Thorac Cardiovasc Surg, 2004, 127(5): 1466-1473.
11.	陈荥, 周武, 罗万俊, 等. 婴幼儿先天性心脏病合并重症肺炎的治疗策略. 中南大学学报(医学版), 2018, 43(11): 1241-1245.
12.	Jortveit J, Leirgul E, Eskedal L, et al. Mortality and complications in 3495 children with isolated ventricular septal defects. Arch Dis Child, 2016, 101(9): 808-813.
13.	Harris KC, Holowachuk S, Pitfield S, et al. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg, 2014, 148(6): 2642-2647.
14.	Carrel T. Early Extubation: A proposed new metric or what was first: The egg or the chicken? Semin Thorac Cardiovasc Surg, 2016, 28(2): 300-301.
15.	Kanter RK, Bove EL, Tobin JR, et al. Prolonged mechanical ventilation of infants after open heart surgery. Crit Care Med, 1986, 14(3): 211-214.
16.	Simsic JM, Kanter KR, Kirshbom PM, et al. Does preoperative mechanical ventilation affect outcomes in neonates undergoing cardiac surgery? Cardiol Young, 2007, 17(1): 90-94.
17.	Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, et al. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg, 2011, 40(1): 179-184.
18.	Pasquali SK, He X, Jacobs M L, et al. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. The Annals of thoracic surgery, 2014, 98(5): 1660-6.

1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2. Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: The current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
3. Vaidyanathan B, Roth SJ, Rao SG, et al. Outcome of ventricular septal defect repair in a developing country. J Pediatr, 2002, 140(6): 736-741.
4. Zhang W, Hu R, Zhu Y, et al. Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation. J Thorac Cardiovasc Surg, 2020, 159(5): 1945-1952.
5. Jacobs JP, O'Brien SM, Pasquali SK, et al. The importance of patient-specific preoperative factors: An analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg, 2014, 98(5): 1653-1658.
6. Hornik CP, He X, Jacobs JP, et al. Complications after the Norwood operation: An analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg, 2011, 92(5): 1734-1740.
7. Brown KL, Ridout DA, Goldman AP, et al. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med, 2003, 31(1): 28-33.
8. Ciociola EC, Kumar KR, Zimmerman KO, et al. Association between preoperative respiratory support and outcomes in paediatric cardiac surgery. Cardiol Young, 2020, 30(1): 66-73.
9. Jacobs JP, Jacobs ML, Austin EH, et al. Quality measures for congenital and pediatric cardiac surgery. World J Pediatr Congenit Heart Surg, 2012, 3(1): 32-47.
10. Bhatt M, Roth SJ, Kumar RK, et al. Management of infants with large, unrepaired ventricular septal defects and respiratory infection requiring mechanical ventilation. J Thorac Cardiovasc Surg, 2004, 127(5): 1466-1473.
11. 陈荥, 周武, 罗万俊, 等. 婴幼儿先天性心脏病合并重症肺炎的治疗策略. 中南大学学报(医学版), 2018, 43(11): 1241-1245.
12. Jortveit J, Leirgul E, Eskedal L, et al. Mortality and complications in 3495 children with isolated ventricular septal defects. Arch Dis Child, 2016, 101(9): 808-813.
13. Harris KC, Holowachuk S, Pitfield S, et al. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg, 2014, 148(6): 2642-2647.
14. Carrel T. Early Extubation: A proposed new metric or what was first: The egg or the chicken? Semin Thorac Cardiovasc Surg, 2016, 28(2): 300-301.
15. Kanter RK, Bove EL, Tobin JR, et al. Prolonged mechanical ventilation of infants after open heart surgery. Crit Care Med, 1986, 14(3): 211-214.
16. Simsic JM, Kanter KR, Kirshbom PM, et al. Does preoperative mechanical ventilation affect outcomes in neonates undergoing cardiac surgery? Cardiol Young, 2007, 17(1): 90-94.
17. Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, et al. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg, 2011, 40(1): 179-184.
18. Pasquali SK, He X, Jacobs M L, et al. Excess costs associated with complications and prolonged length of stay after congenital heart surgery. The Annals of thoracic surgery, 2014, 98(5): 1660-6.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of preoperative duration of mechanical ventilation on prognosis in patients with ventricular septal defect: A retrospective cohort study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content