Risk factors for death after one-stage radical surgery in children with interruption of aortic arch and ventricular septal defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Hailong ,  ZHANG Huijun

Department of Cardiac Surgery, First Hospital of Hebei Medical University, Shijiazhuang, 050000, P. R. China;

Corresponding author：

ZHANG Huijun, Email: 2683292687@qq.com

Keywords：

Interruption of aortic arch; ventricular septal defect; left ventricular outflow tract obstruction; cardiopulmonary bypass; extracorporeal membrane oxygenation; continuous renal replacement therapy; risk factors

DOI：

10.7507/1007-4848.202301049

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the risk factors for death in children with interruption of aortic arch (IAA) and ventricular septal defect (VSD) after one-stage radical surgery. Methods A retrospective analysis was performed on patients with IAA and VSD who underwent one-stage radical treatment in the First Hospital of Hebei Medical University from January 2006 to January 2017. Cox proportional hazards regression model was used to analyze the risk factors for death after the surgery. Results A total of 152 children were enrolled, including 70 males and 82 females. Twenty-two patients died with a mean age of 30.73±9.21 d, and the other 130 patients survived with a mean age of 37.62±11.06 d. The Cox analysis showed that younger age (OR=0.551, 95%CI 0.320-0.984, P=0.004), low body weight (OR=0.632, 95%CI 0.313-0.966, P=0.003), large ratio of VSD diameter/aortic root diameter (VSD/AO, OR=2.547, 95%CI 1.095-7.517, P=0.044), long cardiopulmonary bypass time (OR=1.374, 95%CI 1.000-3.227, P=0.038), left ventricular outflow tract obstruction (LVOTO, OR=3.959, 95%CI 1.123-9.268, P=0.015) were independent risk factors for postoperative death. Conclusion For children with IAA and VSD, younger age, low body weight, large ratio of VSD/AO, long cardiopulmonary bypass time and LVOTO are risk factors for death after one-stage radical surgery.

Citation： SONG Hailong, ZHANG Huijun. Risk factors for death after one-stage radical surgery in children with interruption of aortic arch and ventricular septal defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1300-1304. doi: 10.7507/1007-4848.202301049 Copy

1.	吕蓓, 杜占慧, 陈瑞, 等. 新生儿主动脉弓病变早期干预及临床管理. 中华新生儿科杂志, 2020, 35(6): 406-410.Lv B, Du ZH, Chen R, et al. Congenital aortic arch lesions in neonates: Early intervention and clinical management. Chin J Neonatol, 2020, 35(6): 406-410.
2.	刘爱军, 李斌, 杨明, 等. 主动脉弓离断合并中重度肺动脉高压患儿一期外科手术治疗效果分析. 中国医药, 2020, 15(8): 1225-1228.Liu AJ, Li B, Yang M, et al. Analysis of the effect of one-stage surgical treatment in children with aortic arch disconnection and moderate to severe pulmonary hypertension. China Med, 2020, 15(8): 1225-1228.
3.	Jegatheeswaran A, Jacobs ML, Caldarone CA, et al. Self-reported functional health status following interrupted aortic arch repair: A Congenital Heart Surgeons’ Society study. J Thorac Cardiovasc Surg, 2019, 157(4): 1577-1587.
4.	陈义初, 祁海杰, 汪力, 等. 婴幼儿主动脉弓部病变合并心内畸形的外科诊治分析. 临床外科杂志, 2021, 29(12): 1135-1138.Chen YC, Qi HJ, Wang L, et al. Surgical repair of aortic arch lesions in infants associated with intracardiac anomalies. J Clin Surg, 2021, 29(12): 1135-1138.
5.	Andrianova EI, Naimo PS, Fricke TA, et al. Outcomes of interrupted aortic arch repair in children with biventricular circulation. Ann Thorac Surg, 2021, 111(6): 2050-2058.
6.	许伟滨, 刘琴, 黄景思, 等. 3D打印技术在主动脉弓中断的诊断与治疗中的应用1例. 岭南心血管病杂志, 2018, 24(6): 710-711.Xu WB, Liu Q, Huang JS, et al. Application of 3D printing technology in the diagnosis and treatment of interrupted aortic arch: A case study. South China J Cardiovasc Dis, 2018, 24(6): 710-711.
7.	Wang P, Wu SP, Jiang R, et al. 320-slice CT angiography of an interrupted aortic arch patient relying on collaterals: An addition to classification criteria. Radiol Case Rep, 2019, 14(11): 1382-1384.
8.	许伟滨, 李虹, 黄景思, 等. 新生儿主动脉弓中断一期矫治的疗效及随访结果. 中华胸心血管外科杂志, 2021, 37(12): 721-724.Xu WB, Li H, Huang JS, et al. Single-stage repair of interrupted aortic arches and associated cardiac anomalies in neonatal: The outcomes and follow-up. Chin J Thorac Cardiovasc Surg, 2021, 37(12): 721-724.
9.	McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: A Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2005, 129(2): 343-350.
10.	张凯, 邓喜成, 罗金文, 等. 新生儿主动脉缩窄合并室间隔缺损27例一期手术矫治效果分析. 临床小儿外科杂志, 2020, 19(1): 69-73.Zhang K, Deng XC, Luo JW, et al. Analysis of the effect of one-stage surgical correction in 27 neonates with aortic constriction and ventricular septal defect. J Clin Pediatr Surg, 2020, 19(1): 69-73.
11.	Horbar JD, Edwards EM, Greenberg LT, et al. Variation in performance of neonatal intensive care units in the United States. JAMA Pediatr, 2017, 171(3): e164396.
12.	Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA, 2015, 314(10): 1039-1051.
13.	Krishnamurthy G. Cardiopulmonary bypass in premature and low birth weight neonates: Implications for postoperative care from a neonatologist/intensivist perspective. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2019, 22: 2-9.
14.	张文, 蒋琪, 朱奕帆, 等. 新生儿及婴儿期主动脉弓中断合并室间隔缺损的手术疗效分析. 中华胸心血管外科杂志, 2021, 37(6): 321-325.Zhang W, Jiang Q, Zhu YF, et al. Surgical outcomes of interrupted aortic arch with ventricular septal defect in neonates and infants. Chin J Thorac Cardiovasc Surg, 2021, 37(6): 321-325.
15.	黄静, 林新祝, 郑直, 等. 胎龄<32周且出生体重<1 500 g早产儿支气管肺发育不良的发生及其严重程度的影响因素. 中国当代儿科杂志, 2022, 24(12): 1326-1333.Hunag J, Lin XZ, Zheng Z, et al. Influencing factors for the development and severity of bronchopulmonary dysplasia in preterm infants with a gestational age of<32 weeks and a birth weight of<1 500 g. Chin J Contemp Pediatr, 2022, 24(12): 1326-1333.
16.	Lagier D, Velly LJ, Guinard B, et al. Perioperative open-lung approach, regional ventilation, and lung injury in cardiac surgery. Anesthesiology, 2020, 133(5): 1029-1045.
17.	陈晓博, 何少茹, 郑曼利, 等. 小婴儿室间隔缺损修补术后左心室肌力指数和外周血管阻力指数的随访评估. 岭南心血管病杂志, 2022, 28(2): 110-115.Chen XB, He SR, Zheng ML, et al. Follow up evaluation of left ventricular Smith-Madigan inotropy index and systemic vascular resistance index after surgical repair of ventricular septal defect in infants. South China J Cardiovasc Dis, 2022, 28(2): 110-115.
18.	Korsuize NA, van Wijk A, Haas F, et al. Predictors of left ventricular outflow tract obstruction after primary interrupted aortic arch repair. Pediatr Cardiol, 2021, 42(8): 1665-1675.

1. 吕蓓, 杜占慧, 陈瑞, 等. 新生儿主动脉弓病变早期干预及临床管理. 中华新生儿科杂志, 2020, 35(6): 406-410.Lv B, Du ZH, Chen R, et al. Congenital aortic arch lesions in neonates: Early intervention and clinical management. Chin J Neonatol, 2020, 35(6): 406-410.
2. 刘爱军, 李斌, 杨明, 等. 主动脉弓离断合并中重度肺动脉高压患儿一期外科手术治疗效果分析. 中国医药, 2020, 15(8): 1225-1228.Liu AJ, Li B, Yang M, et al. Analysis of the effect of one-stage surgical treatment in children with aortic arch disconnection and moderate to severe pulmonary hypertension. China Med, 2020, 15(8): 1225-1228.
3. Jegatheeswaran A, Jacobs ML, Caldarone CA, et al. Self-reported functional health status following interrupted aortic arch repair: A Congenital Heart Surgeons’ Society study. J Thorac Cardiovasc Surg, 2019, 157(4): 1577-1587.
4. 陈义初, 祁海杰, 汪力, 等. 婴幼儿主动脉弓部病变合并心内畸形的外科诊治分析. 临床外科杂志, 2021, 29(12): 1135-1138.Chen YC, Qi HJ, Wang L, et al. Surgical repair of aortic arch lesions in infants associated with intracardiac anomalies. J Clin Surg, 2021, 29(12): 1135-1138.
5. Andrianova EI, Naimo PS, Fricke TA, et al. Outcomes of interrupted aortic arch repair in children with biventricular circulation. Ann Thorac Surg, 2021, 111(6): 2050-2058.
6. 许伟滨, 刘琴, 黄景思, 等. 3D打印技术在主动脉弓中断的诊断与治疗中的应用1例. 岭南心血管病杂志, 2018, 24(6): 710-711.Xu WB, Liu Q, Huang JS, et al. Application of 3D printing technology in the diagnosis and treatment of interrupted aortic arch: A case study. South China J Cardiovasc Dis, 2018, 24(6): 710-711.
7. Wang P, Wu SP, Jiang R, et al. 320-slice CT angiography of an interrupted aortic arch patient relying on collaterals: An addition to classification criteria. Radiol Case Rep, 2019, 14(11): 1382-1384.
8. 许伟滨, 李虹, 黄景思, 等. 新生儿主动脉弓中断一期矫治的疗效及随访结果. 中华胸心血管外科杂志, 2021, 37(12): 721-724.Xu WB, Li H, Huang JS, et al. Single-stage repair of interrupted aortic arches and associated cardiac anomalies in neonatal: The outcomes and follow-up. Chin J Thorac Cardiovasc Surg, 2021, 37(12): 721-724.
9. McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: A Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2005, 129(2): 343-350.
10. 张凯, 邓喜成, 罗金文, 等. 新生儿主动脉缩窄合并室间隔缺损27例一期手术矫治效果分析. 临床小儿外科杂志, 2020, 19(1): 69-73.Zhang K, Deng XC, Luo JW, et al. Analysis of the effect of one-stage surgical correction in 27 neonates with aortic constriction and ventricular septal defect. J Clin Pediatr Surg, 2020, 19(1): 69-73.
11. Horbar JD, Edwards EM, Greenberg LT, et al. Variation in performance of neonatal intensive care units in the United States. JAMA Pediatr, 2017, 171(3): e164396.
12. Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA, 2015, 314(10): 1039-1051.
13. Krishnamurthy G. Cardiopulmonary bypass in premature and low birth weight neonates: Implications for postoperative care from a neonatologist/intensivist perspective. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2019, 22: 2-9.
14. 张文, 蒋琪, 朱奕帆, 等. 新生儿及婴儿期主动脉弓中断合并室间隔缺损的手术疗效分析. 中华胸心血管外科杂志, 2021, 37(6): 321-325.Zhang W, Jiang Q, Zhu YF, et al. Surgical outcomes of interrupted aortic arch with ventricular septal defect in neonates and infants. Chin J Thorac Cardiovasc Surg, 2021, 37(6): 321-325.
15. 黄静, 林新祝, 郑直, 等. 胎龄<32周且出生体重<1 500 g早产儿支气管肺发育不良的发生及其严重程度的影响因素. 中国当代儿科杂志, 2022, 24(12): 1326-1333.Hunag J, Lin XZ, Zheng Z, et al. Influencing factors for the development and severity of bronchopulmonary dysplasia in preterm infants with a gestational age of<32 weeks and a birth weight of<1 500 g. Chin J Contemp Pediatr, 2022, 24(12): 1326-1333.
16. Lagier D, Velly LJ, Guinard B, et al. Perioperative open-lung approach, regional ventilation, and lung injury in cardiac surgery. Anesthesiology, 2020, 133(5): 1029-1045.
17. 陈晓博, 何少茹, 郑曼利, 等. 小婴儿室间隔缺损修补术后左心室肌力指数和外周血管阻力指数的随访评估. 岭南心血管病杂志, 2022, 28(2): 110-115.Chen XB, He SR, Zheng ML, et al. Follow up evaluation of left ventricular Smith-Madigan inotropy index and systemic vascular resistance index after surgical repair of ventricular septal defect in infants. South China J Cardiovasc Dis, 2022, 28(2): 110-115.
18. Korsuize NA, van Wijk A, Haas F, et al. Predictors of left ventricular outflow tract obstruction after primary interrupted aortic arch repair. Pediatr Cardiol, 2021, 42(8): 1665-1675.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for death after one-stage radical surgery in children with interruption of aortic arch and ventricular septal defect

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content