Background:This study evaluated differential inflammatory response to cardiopulmonary bypass reoxygenation in tetralogy of Fallot repair.Methods:We performed a retrospective study at a cardiovascular center from 2012 ...Background:This study evaluated differential inflammatory response to cardiopulmonary bypass reoxygenation in tetralogy of Fallot repair.Methods:We performed a retrospective study at a cardiovascular center from 2012 to 2018,including 500 patients aged 1 week–18 years who received complete repair of tetralogy of Fallot.Patients were grouped according to tertiles of preoperative RVOT gradient on echocardiography into mild,moderate,and severe stenosis.We measured the highest perfusate oxygenation(PpO_(2))during aortic occlusion as independent variable.Primary outcome was systemic inflammatory response syndrome(SIRS)within 7 days postoperatively or the time of death or discharge.Results:Overall,rate of SIRS was 24.2% without significant differences among three groups(P>0.05).Older age,male,and smaller indexed left ventricular end-diastolic volume is independent risk factor of SIRS.There were significant interactions between RVOT stenosis and PpO2 on SIRS(P interaction=0.011):higher PpO_(2) was associated with a greater SIRS risk among combined moderate and severe stenotic children(OR 1.46395%CI[1.080,1.981]per-SD increase,P=0.014)but not among mild stenotic children(OR 0.900[0.608,1.333]per-SD increase;P=0.600),independent of covariates.Conclusion:The association of PpO_(2) with SIRS was modified by RVOT obstruction severity in tetralogy of Fallot repair.展开更多
Baekground Although a lot of studies have been performed on the long term outcome in adults with repaired tetralogy of Fallot （TOF） in developed countries, but rare information for primary correction of adult TOF is...Baekground Although a lot of studies have been performed on the long term outcome in adults with repaired tetralogy of Fallot （TOF） in developed countries, but rare information for primary correction of adult TOF is available. The research focusing on the effect of transanular patch （TAP） for primary correction of TOF in adulthood is still absent. Via retrograde analysis of 7-year follow-up, this study was designed to explore the effect of the transanular patch for primary correction in adult TOF on the surgical outcome, postoperative cardiac function and morbidity, as well as to address the management of the complication. Methods A total of 151 consecutive adult patients （age ≥ 18） who underwent primary radical correction of TOF form 2007-2014 were selected and divided into TAP demographic statistic characteristics, and non-TAP groups based on the EACTS database. Results of echocardiography, color-Doppler echocardiography, cardiovascular enhanced contrast computed tomography （CT）, and/or cardiac catheterization; intraoperative information, postoperative results and outcomes were reported. During follow-up, short term was defined within 3 months after discharge, and midterm was defined as 6-12 months after discharge. Results Total postoperative mortality was 5.96% in all the cases, 6.96% in TAP group, and 2.78% （1/36） in non-TAP group. There was no significant difference between two groups. Follow-up period ranged from 3 months to 62 months. Readmission occurred and was followed by medical treatment without re-do surgery in 6 cases （3.97%）. The short term echocardiography demonstrated that pulmonary regurgitation and short term tricuspid regurgitation after discharge in TAP group were more severe （P 〈 0.001）. The short term residual pulmonary stenosis （RVOTO） severity after discharge in TAP group was less severe （P = 0.018）. Midterm echocardiography after discharge demonstrated pulmonary regurgitation and tricuspid regurgitation in TAP group were still more severe （P = 0.003）. The severity of residual pulmonary stenosis in TAP group was less severe （P = 0.044）. Multivariate unconditional logistic regression analysis showed that risk factors for mortality of adult TOF primary correction included： the acquirement of repeated cardiopulmonary bypass, OR = 126.28 （5.17 - 3082.23）, P = 0.003; the application of DHCA, OR = 61.08（2.26 - 1652.51）, P = 0.015; postoperative pulmonary regurgitation, OR = 33.84（2.53 - 452.53）, P = 0.008, long intensive care time, OR = 1.00 （1.00 - 1.01）, P = 0.012. The first three variables were high risk factors. Conclusions Primary radical correction of adult TOF has a good outcome, acceptable morbidity and mortality rates with mid-term surgical outcome in terms of effort tolerance. The acquirement of repeated cardiopulmonary bypass, the application of DHCA and postoperative pulmonary regurgitation are high risk factors of mortality. IS Chin J Cardiol 2015; 16 （2）： 72 - 79]展开更多
基金This work was supported by the National Natural Science Foundation of China(82000305,81974033)the National Natural Science Foundation of Jiangsu Province(BK20191069).
文摘Background:This study evaluated differential inflammatory response to cardiopulmonary bypass reoxygenation in tetralogy of Fallot repair.Methods:We performed a retrospective study at a cardiovascular center from 2012 to 2018,including 500 patients aged 1 week–18 years who received complete repair of tetralogy of Fallot.Patients were grouped according to tertiles of preoperative RVOT gradient on echocardiography into mild,moderate,and severe stenosis.We measured the highest perfusate oxygenation(PpO_(2))during aortic occlusion as independent variable.Primary outcome was systemic inflammatory response syndrome(SIRS)within 7 days postoperatively or the time of death or discharge.Results:Overall,rate of SIRS was 24.2% without significant differences among three groups(P>0.05).Older age,male,and smaller indexed left ventricular end-diastolic volume is independent risk factor of SIRS.There were significant interactions between RVOT stenosis and PpO2 on SIRS(P interaction=0.011):higher PpO_(2) was associated with a greater SIRS risk among combined moderate and severe stenotic children(OR 1.46395%CI[1.080,1.981]per-SD increase,P=0.014)but not among mild stenotic children(OR 0.900[0.608,1.333]per-SD increase;P=0.600),independent of covariates.Conclusion:The association of PpO_(2) with SIRS was modified by RVOT obstruction severity in tetralogy of Fallot repair.
基金supported by The Twelfth National Five-Year Plan(No.2011BAI11B22)
文摘Baekground Although a lot of studies have been performed on the long term outcome in adults with repaired tetralogy of Fallot （TOF） in developed countries, but rare information for primary correction of adult TOF is available. The research focusing on the effect of transanular patch （TAP） for primary correction of TOF in adulthood is still absent. Via retrograde analysis of 7-year follow-up, this study was designed to explore the effect of the transanular patch for primary correction in adult TOF on the surgical outcome, postoperative cardiac function and morbidity, as well as to address the management of the complication. Methods A total of 151 consecutive adult patients （age ≥ 18） who underwent primary radical correction of TOF form 2007-2014 were selected and divided into TAP demographic statistic characteristics, and non-TAP groups based on the EACTS database. Results of echocardiography, color-Doppler echocardiography, cardiovascular enhanced contrast computed tomography （CT）, and/or cardiac catheterization; intraoperative information, postoperative results and outcomes were reported. During follow-up, short term was defined within 3 months after discharge, and midterm was defined as 6-12 months after discharge. Results Total postoperative mortality was 5.96% in all the cases, 6.96% in TAP group, and 2.78% （1/36） in non-TAP group. There was no significant difference between two groups. Follow-up period ranged from 3 months to 62 months. Readmission occurred and was followed by medical treatment without re-do surgery in 6 cases （3.97%）. The short term echocardiography demonstrated that pulmonary regurgitation and short term tricuspid regurgitation after discharge in TAP group were more severe （P 〈 0.001）. The short term residual pulmonary stenosis （RVOTO） severity after discharge in TAP group was less severe （P = 0.018）. Midterm echocardiography after discharge demonstrated pulmonary regurgitation and tricuspid regurgitation in TAP group were still more severe （P = 0.003）. The severity of residual pulmonary stenosis in TAP group was less severe （P = 0.044）. Multivariate unconditional logistic regression analysis showed that risk factors for mortality of adult TOF primary correction included： the acquirement of repeated cardiopulmonary bypass, OR = 126.28 （5.17 - 3082.23）, P = 0.003; the application of DHCA, OR = 61.08（2.26 - 1652.51）, P = 0.015; postoperative pulmonary regurgitation, OR = 33.84（2.53 - 452.53）, P = 0.008, long intensive care time, OR = 1.00 （1.00 - 1.01）, P = 0.012. The first three variables were high risk factors. Conclusions Primary radical correction of adult TOF has a good outcome, acceptable morbidity and mortality rates with mid-term surgical outcome in terms of effort tolerance. The acquirement of repeated cardiopulmonary bypass, the application of DHCA and postoperative pulmonary regurgitation are high risk factors of mortality. IS Chin J Cardiol 2015; 16 （2）： 72 - 79]
