Predictors of Health-Related Quality of Life in Children with Cyanotic Heart Disease Who Underwent Palliative and Total Repair

Background:Studies on predictors of health-related quality of life(HRQOL)in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce.Therefore,we aimed to identify such predictors in children who received the modified Blalock–Taussig shunt(MBTS)and those who underwent total repair.Methods:In this historical cohort and concurrent follow-up study,data of children who underwent MBTS at the age of 0–3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained.Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation.Between January and December 2018,the“Pediatric Quality of Life Inventory 4.0 Generic Core Scales”with both child self-report and parent proxy-report scores were used to examine the HRQOL.Multivariate linear regression analysis was performed to identify independent predictors of HRQOL.Beta-coefficient(β)and 95% confidence intervals(95%CIs)were calculated and considered statistically significant at p<0.05.Results:Among the 380 enrolled children,148 died,122 survived and waited for total repair,and 110 survived after total repair.In the multivariate analysis,chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents(β[95%CI]:−0.42[−0.81,−0.03]and−0.49[−0.89,−0.09],respectively).Total repair was a predictor of higher physical HRQOL according to both parents and children(β[95%CI]:0.33[0.09,0.57]and 0.70[0.36,1.03],respectively).A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age(β[95%CI]:0.012[0.001,0.022]).In the total repair subgroup,undergoing the Fontan procedure(vs.Glenn procedure)was a predictor for lower physical HRQOL reported by the parents(β[95%CI]:−0.82[−1.52,−0.13]).Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL(β[95%CI]:0.018[0.001,0.034]and 0.012[0.0001,0.04],respectively).Conclusions:Successful total repair was a predictor of higher physical HRQOL,and younger age during MBTS surgery was a predictor of higher psychological HRQOL in children with cyanotic heart disease.Higher socioeconomic status was a predictor of both physical and psychological HRQOL following total repair[Thai Clinical Trials Registry:TCTR20161221003].

Outcomes of Transcatheter Closure in Outlet-Type Ventricular Septal Defect after 1 Year

Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.