Predictors of a complicated course after surgical repair of tetralogy of Fallot.
Length of hospital stay
major adverse event
morbidity
mortality
tetralogy of Fallot
Journal
Turk gogus kalp damar cerrahisi dergisi
ISSN: 1301-5680
Titre abrégé: Turk Gogus Kalp Damar Cerrahisi Derg
Pays: Turkey
ID NLM: 100887967
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
29
09
2019
accepted:
12
01
2020
entrez:
20
6
2020
pubmed:
20
6
2020
medline:
20
6
2020
Statut:
epublish
Résumé
In this study, we aimed to evaluate the patient and surgical factors affecting prolonged hospital stay and major adverse events after surgical repair of tetralogy of Fallot and to identify the predictors of a complicated course after surgical repair. A total of 170 consecutive patients (96 males, 74 females; median age 12 months; range, 1 to 192 months) who underwent surgical repair of tetralogy of Fallot between January 2015 and April 2018 were retrospectively reviewed. A mechanical ventilation duration of >24 h, an intensive care unit stay of >3 days, and a hospital stay of >7 days were considered as prolonged. Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, renal failure, diaphragmatic paralysis, neurological deficit, sudden circulatory arrest, need for extracorporeal membrane oxygenation, and death were considered as major adverse events. The median time to hospital discharge was 8.0 (range, 5.0 to 40.0) days. Higher preoperative hematocrit levels prolonged the length of hospital stay (odds ratio: 1.12, 95% confidence interval 1.1-1.2, p<0.001). A total of 28 major adverse events were observed in 17 patients (10%). Lower pulmonary artery annulus Z-score (odds ratio: 0.5, 95% confidence interval 0.3-0.9, p=0.01) and residual ventricular septal defects (odds ratio: 54.6, 95% confidence interval 1.6-1,874.2, p=0.03) were found to increase mortality. Residual ventricular septal defect was also a risk factor for major adverse events (odds ratio: 12.4, 95% confidence interval 1.5-99.9, p=0.02). Preoperative and operative factors such as high preoperative hematocrit, low preoperative oxygen saturation, low pulmonary annulus Z-score, Down syndrome, residual ventricular septal defects, and the use transannular patch were found to be associated with prolonged length of hospital stay, prolonged mechanical ventilation, prolonged intensive care unit stay, and increased development of major adverse events.
Sections du résumé
BACKGROUND
BACKGROUND
In this study, we aimed to evaluate the patient and surgical factors affecting prolonged hospital stay and major adverse events after surgical repair of tetralogy of Fallot and to identify the predictors of a complicated course after surgical repair.
METHODS
METHODS
A total of 170 consecutive patients (96 males, 74 females; median age 12 months; range, 1 to 192 months) who underwent surgical repair of tetralogy of Fallot between January 2015 and April 2018 were retrospectively reviewed. A mechanical ventilation duration of >24 h, an intensive care unit stay of >3 days, and a hospital stay of >7 days were considered as prolonged. Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, renal failure, diaphragmatic paralysis, neurological deficit, sudden circulatory arrest, need for extracorporeal membrane oxygenation, and death were considered as major adverse events.
RESULTS
RESULTS
The median time to hospital discharge was 8.0 (range, 5.0 to 40.0) days. Higher preoperative hematocrit levels prolonged the length of hospital stay (odds ratio: 1.12, 95% confidence interval 1.1-1.2, p<0.001). A total of 28 major adverse events were observed in 17 patients (10%). Lower pulmonary artery annulus Z-score (odds ratio: 0.5, 95% confidence interval 0.3-0.9, p=0.01) and residual ventricular septal defects (odds ratio: 54.6, 95% confidence interval 1.6-1,874.2, p=0.03) were found to increase mortality. Residual ventricular septal defect was also a risk factor for major adverse events (odds ratio: 12.4, 95% confidence interval 1.5-99.9, p=0.02).
CONCLUSION
CONCLUSIONS
Preoperative and operative factors such as high preoperative hematocrit, low preoperative oxygen saturation, low pulmonary annulus Z-score, Down syndrome, residual ventricular septal defects, and the use transannular patch were found to be associated with prolonged length of hospital stay, prolonged mechanical ventilation, prolonged intensive care unit stay, and increased development of major adverse events.
Identifiants
pubmed: 32551156
doi: 10.5606/tgkdc.dergisi.2020.18829
pmc: PMC7298368
doi:
Types de publication
Journal Article
Langues
eng
Pagination
264-273Informations de copyright
Copyright © 2020, Turkish Society of Cardiovascular Surgery.
Déclaration de conflit d'intérêts
Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Références
J Thorac Cardiovasc Surg. 2013 Apr;145(4):1046-1057.e1
pubmed: 22835225
Congenit Heart Dis. 2015 May-Jun;10(3):254-62
pubmed: 25059746
Am J Surg. 2009 Apr;197(4):479-84
pubmed: 19246026
J Pediatr. 2002 Jul;141(1):51-8
pubmed: 12091851
J Am Heart Assoc. 2018 May 16;7(11):
pubmed: 29769202
Circulation. 2010 Nov 30;122(22):2254-63
pubmed: 21098447
Circulation. 2000 Nov 7;102(19 Suppl 3):III123-9
pubmed: 11082374
J Thorac Cardiovasc Surg. 2013 Oct;146(4):868-73
pubmed: 23312975
J Thorac Cardiovasc Surg. 2014 Feb;147(2):713-7
pubmed: 23602127
Ann Thorac Surg. 2010 Sep;90(3):813-9; discussion 819-20
pubmed: 20732501
J Thorac Cardiovasc Surg. 2003 Sep;126(3):703-10
pubmed: 14502142
Ann Thorac Surg. 2002 Aug;74(2):464-73
pubmed: 12173830
Ann Thorac Surg. 2018 Nov;106(5):1446-1451
pubmed: 29969617
Ann Thorac Surg. 2014 Nov;98(5):1660-6
pubmed: 25201725
J Pediatr. 2003 Jul;143(1):67-73
pubmed: 12915826
Ann Pediatr Cardiol. 2014 Jan;7(1):13-8
pubmed: 24701079
Ann Thorac Surg. 2014 Jun;97(6):2154-9
pubmed: 24444872
Ann Thorac Surg. 2008 Dec;86(6):1928-35
pubmed: 19022010