Surgical outcomes of neonates with critical and complex congenital heart diseases in a single center: a 15-year experience
10.3760/cma.j.issn.2096-2932.2019.06.001
- VernacularTitle:新生儿复杂先天性心脏病15年治疗分析
- Author:
Huili ZHANG
1
;
Shoujun LI
;
Jun YAN
;
Xu WANG
;
Zhongdong HUA
;
Qiang WANG
Author Information
1. 国家心血管病中心
- Keywords:
Cardiovascular abnormalities;
Congenital heart disease;
Operation;
Infant,newborn
- From:Chinese Journal of Neonatology
2019;34(6):401-407
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the surgical outcomes of neonates with critical and complex congenital heart diseases in the last 15 years to determine the optimal operation time and improve the prognosis.Method From January 2004 to December 2018,data of patients with complex congenital heart disease (CHD) who received surgery in our center were retrospectively analysed.All patients were diagnosed using echocardiography,some patients also received multidetector computed tomography (MDCT) examination.According to the operation date,patients were assigned into three groups:2004-2008,2009-2013 and 2014-2018 groups.Follow-up data were obtained from outpatient check-up and telephone interview.Result A total of 357 (261 males and 96 females) neonates were included.They received the operation at 2-28 days after birth and their body weights were 2 100 ～ 4 900 g.13.4％ (48/357) were diagnosed before birth.Percutaneous oxygen saturation (SpO2) ＜ 0.95 were detected in 315 patients (88.2％,315/357),among whom 60 had SpO2 ≤0.60(19.0％,60/315).Cardiac murmur were detected in 181 patients (50.7％,181/357).Among the 357 patients,221 neonates had transposition of the great arteries (TGA),55 had total abnormal pulmonary venous connection (TAPVC),43 had pulmonary atresia and intact ventricular septum (PA/IVS) and severe pulmonary stenosis and intact ventricular septum (SPS/IVS),20 had severe coarctation of the aorta (CoA)/interrupted aortic arch (IAA)/severe aortic stenosis (AS)/hypoplastic left heart syndrome (HLHS) and 18 had other types of complex CHD.The rate of onestage repair was 83.8％ (299/357) and 58 neonates underwent palliative surgery.28 patients died in hospital (7.8％,28/357).The rate of prenatal diagnosis in three groups increased [3.0％ (2/67),6.3％ (7/111),21.8％ (39/179)] and in-hospital mortality of all patients,especially patients with TGA,were remarkably decreased in the last 15 years [11.9％ (8/67),5.4％ (6/111),2.8％ (5/179)].329 patients survived after surgery and discharged.The follow-up rate was 97.9％ (322/329),7 patients were lost during follow-up,the median duration of follow-up was 63 months (3 ～ 183 months).5 died during follow-up,9 underwent second-stage radical operation,3 had re-operation due to the RVOT/LVOT stenosis.The majority of survivors were asymptomatic and with Ⅰ degree (NYHA classification) during follow-up.Conclusion Cyanosis is the most common manifestation in neonates with complex CHD.The rate of prenatal diagnosis increased gradually in the last 15 years,and in-hospital mortality of all patients,especially patients with TGA,was remarkably decreased.Most symptomatic neonates with complex CHD can survive radical operations with high success rate and good curative effect.Palliative procedures are also important for critical and complex CHD.
