严重左心功能不全的左冠状动脉起源于肺动脉术后体外膜肺氧合辅助的风险因素分析

Analysis of the risk factors for extracorporeal membrane oxygenation use after surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary artery combined with severe left ventricular dysfunction

目的探讨严重左心功能不全的左冠状动脉起源于肺动脉(anomalous origin of the left coronary artery from the pulmonary artery,ALCAPA)患儿术后近期临床结果和体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助风险预测因素。方法纳入2013—2020年在阜外医院小儿心脏中心行冠状动脉移植术的严重左心功能不全(左室射血分数<40%)ALCAPA患者。将患者分为ECMO组和非ECMO组。比较两组患者的临床资料。结果共纳入64例患者,ECMO组7例,其中男4例、女3例,年龄(6.58±1.84)个月;非ECMO组57例,其中男30例、女27例,年龄(4.34±2.56)个月。全组患儿住院死亡4例(6.25%),其中ECMO组2例,非ECMO组2例。ECMO组术后并发症发生率高于非ECMO组,差异有统计学意义(P=0.041)。两组主动脉阻断(aortic cross-clamping,ACC)时间[(89.57±13.66)min vs.(61.58±19.57)min,P=0.039]、体外循环时间[254(153,417)min vs.106(51,192)min,P=0.013]、术前左室舒张末期内径/体表面积[(132.32±14.71)mm/m^(2)vs.(108.00±29.64)mm/m2,P=0.040]差异有统计学意义。多因素logistic回归分析显示ACC时间是术后ECMO辅助的独立风险预测因素(P=0.005)。采用ACC时间预测术后ECMO辅助的受试者工作特征曲线下面积为0.757,最佳截断值为66 min,灵敏度85.70%,特异度66.70%。结论ACC时间是预测严重左心功能不全的ALCAPA患者术后ECMO辅助的独立风险因素,ACC时间>66 min的患者术后ECMO辅助的风险明显升高。

Objective To analyze the early outcomes of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)patients with severe left ventricular dysfunction after surgical repair,and to explore the predictors for extracorporeal membrane oxygenation(ECMO)support for these patients.Methods The clinical data of ALCAPA patients with severe left ventricular dysfunction(left ventricular ejection fraction<40%)who underwent coronary artery reimplantation in the pediatric center of our hospital from 2013 to 2020 were retrospectively analyzed.The patients were divided into an ECMO group and a non-ECMO group.Clinical data of the two groups were compared and analyzed.Results A total of 64 ALCAPA patients were included.There were 7 patients in the ECMO group,including 4 males and 3 females aged 6.58±1.84 months.There were 57 pateints in the non-ECMO group,including 30 males and 27 females aged 4.34±2.56 months.The mortality of the patients was 6.25%(4/64),including 2 patients in the ECMO group,and 2 in the non-ECMO group.The postoperative complications rate was significantly higher in the ECMO group than that in the non-ECMO group(P=0.041).There were statistical differences in the cardiopulmonary bypass time[254(153,417)min vs.106(51,192)min,P=0.013],aortic cross-clamping(ACC)time(89.57±13.66 min vs.61.58±19.57 min,P=0.039),and preoperative left ventricular end-diastolic diameter/body surface area(132.32±14.71 mm/m^(2)vs.108.00±29.64 mm/m2,P=0.040)between the two groups.Multivariate logistic regression analysis showed that ACC time was an independent risk factor for postoperative ECMO support(P=0.005).Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.757,the sensitivity was 85.70%,specificity was 66.70%,with the cut-off value of 66 min.Conclusion ACC time is an independent risk factor for postoperative ECMO support.Patients with an ACC time>66 min have a significantly higher risk for ECMO support after the surgery.