在治疗低可塑性左心综合征和其变体中的手术途径和风险类别
V Reed LaSala1, Halil Beqaj2, Sophia Jackman2
1Section of Pediatric and Congenital Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
JTCVS open
|July 9, 2025
概括
低可塑性左心综合征 (HLHS) 的新风险类别有效预测死亡率,并指导新生儿的手术策略. 这些类别改善了HLHS患者的决策.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 生产性心脏手术 手术 生产心脏手术
- 新生儿重症监护中心
背景情况:
- 缺血性左心综合征 (HLHS) 呈现出不同的风险因素,影响结果.
- 目前对HLHS风险因素分布和手术策略有效性的理解有限.
研究的目的:
- 定义和验证新生儿患有低可塑性左心综合征 (HLHS) 的风险类别.
- 将这些风险类别与外科手术策略和患者结果相关联.
- 在HLHS管理中建立预测风险模型的基础.
主要方法:
- 对233名接受手术的HLHS新生儿 (2006-2023) 的回顾性图表审查.
- 风险类别标准由专家协商一致制定,并使用Cox回归对死亡率进行细化.
- 定义的风险类别的追溯应用到历史队列.
主要成果:
- 患者分为标准 (32%),中间 (55%) 和高风险 (13%) 类别.
- 手术策略,包括诺伍德手术和混合手术,与风险类别有显著的相关性 (P < .001).
- 在所有风险类别中,死亡率 (手术和长期) 显著增加 (P < .001).
结论:
- 开发的风险类别根据死亡风险准确地分层了HLHS患者.
- 这些类别与所选择的外科手术策略有很强的相关性.
- 风险分层框架可以指导临床决策,并为HLHS的预测模型开发提供信息.
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