Preoperative versus postoperative survival in patients with univentricular heart: a nationwide, retrospective study of patients born in 1990-2015.

Autor:	Erikssen G; Department of Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway gunnar.erikssen@yahoo.com., Liestøl K; Department of Informatics, University of Oslo, Oslo, Norway., Aboulhosn J; Ahmanson Adult Congenital Heart Disease Center, UCLA, Los Angeles, California, USA., Wik G; Department of Pediatrics, Sørlandet Hospital, Kristiansand, Norway., Holmstrøm H; Department of Women's and Children's, Oslo University Hospital, Oslo, Norway.; Department of Women's and Children's, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Døhlen G; Department of Women's and Children's, Oslo University Hospital, Oslo, Norway., Gjesdal O; Department of Cardiology, Oslo University Hospital rikshospitalet, Oslo, Norway., Birkeland S; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway., Hoel TN; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway., Saatvedt KJ; Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway., Seem E; Department of Coardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway., Thaulow E; Department of Pediatric Cardiology, Oslo universitetssykehus Rikshospitalet, Oslo, Norway., Estensen ME; Department of Cardiology, Oslo University Hospital, Oslo, Norway., Lindberg HL; Department of Cardiothoracic Surgery, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Jul 25; Vol. 13 (7), pp. e069531. Date of Electronic Publication: 2023 Jul 25.
DOI:	10.1136/bmjopen-2022-069531
Abstrakt:	Objectives: Few data exist on mortality among patients with univentricular heart (UVH) before surgery. Our aim was to explore the results of intention to perform surgery by estimating preoperative vs postoperative survival in different UVH subgroups. Design: Retrospective. Setting: Tertiary centre for congenital cardiology and congenital heart surgery. Participants: All 595 Norwegian children with UVH born alive from 1990 to 2015, followed until 31 December 2020. Results: One quarter (151/595; 25.4%) were not operated. Among these, only two survived, and 125/149 (83.9%) died within 1 month. Reasons for not operating were that surgery was not feasible in 31.1%, preoperative complications in 25.2%, general health issues in 23.2% and parental decision in 20.5%. In total, 327/595 (55.0%) died; 283/327 (86.5%) already died during the first 2 years of life. Preoperative survival varied widely among the UVH subgroups, ranging from 40/65 (61.5%) among patients with unbalanced atrioventricular septal defect to 39/42 (92.9%) among patients with double inlet left ventricle. Postoperative survival followed a similar pattern. Postoperative survival among patients with hypoplastic left heart syndrome (HLHS) improved significantly (5-year survival, 42.5% vs 75.3% among patients born in 1990-2002 vs 2003-2015; p<0.0001), but not among non-HLHS patients (65.7% vs 72.6%; p=0.22)-among whom several subgroups had a poor prognosis similar to HLHS. A total of 291/595 patients (48.9%) had Fontan surgery CONCLUSIONS: Surgery was refrained in one quarter of the patients, among whom almost all died shortly after birth. Long-term prognosis was largely determined during the first 2 years. There was a strong concordance between preoperative and postoperative survival. HLHS survival was improved, but non-HLHS survival did not change significantly. This study demonstrates the complications and outcomes encountering newborns with UVH at all major stages of preoperative and operative treatment. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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