Abstract
BackgroundWe carried out a retrospective data review of patients with systemic to pulmonary shunts that underwent surgical repair between February 1990 and February 2012 in order to assess preoperative pulmonary vascular dynamic risk factors for predicting early and late deaths due presumably to pulmonary vascular disease.Methods and ResultsA total of 1024 cases of congenital systemic-to-pulmonary shunt and advanced pulmonary vascular disease beyond infancy and early childhood were closed surgically. The mean follow up duration was 8.5±5.5 (range 0.7 to 20) years. Sixty-one in-hospital deaths (5.96%, 61/1024) occurred after the shunt closure procedure and there were 46 late deaths, yielding 107 total deaths. We analyzed preoperative pulmonary vascular resistance index (PVRI), pulmonary vascular resistance index on pure oxygen challenge (PVRIO), difference between PVRI and PVRIO (PVRID), Qp∶Qs, and Rp∶Rs as individual risk predictors. The results showed that these individual factors all predicted in-hospital death and total death with PVRIO showing better performance than other risk factors. A multivariable Cox regression model was built,and suggested that PVRID and Qp∶Qs were informative factors for predicting survival time from late death and closure of congenital septal defects was safe with a PVRIO<10.3 WU.m2 and PVRID>7.3 WU.m2 on 100% oxygen.ConclusionsAll 4 variables, PVRI, PVRIO, PVRID and Qp∶Qs, should be considered in deciding surgical closure of congenital septal defects and a PVRIO<10.3 WU.m2 and PVRID>7.3 WU.m2 on 100% oxygen are associated with a favorable risk benefit profile for the procedure.
Highlights
Cardiac defects are among the most common causes of congenital disease with atrial and ventricular intracardiac shunts accounting for a significant proportion of such malformations
All 4 variables, pulmonary vascular resistance index (PVRI), PVRIO, PVRID and Qp:Qs, should be considered in deciding surgical closure of congenital septal defects and a PVRIO,10.3 WU.m2 and PVRID.7.3 WU.m2 on 100% oxygen are associated with a favorable risk benefit profile for the procedure
This has led to a lack of clear guidelines for all surgical centers, especially those in parts of the world where surgeons have to deal with a large population of untreated older patients with congenital heart disease (CHD) and elevated pulmonary vascular resistance (PVR)
Summary
Cardiac defects are among the most common causes of congenital disease with atrial and ventricular intracardiac shunts accounting for a significant proportion of such malformations. It remains unclear which preoperative hemodynamic variables best predict a satisfactory surgical outcome, i.e., acceptably low pulmonary vascular resistance (PVR) after operation [1,2]. Few reports have been published that present the results of studies designed to determine the risk factors (using multivariate analysis) affecting the outcome of the surgical procedures to treat intracardiac shunts. This has led to a lack of clear guidelines for all surgical centers, especially those in parts of the world where surgeons have to deal with a large population of untreated older patients with congenital heart disease (CHD) and elevated PVR. We carried out a retrospective data review of patients with systemic to pulmonary shunts that underwent surgical repair between February 1990 and February 2012 in order to assess preoperative pulmonary vascular dynamic risk factors for predicting early and late deaths due presumably to pulmonary vascular disease
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
