METHODS: The retrospective single-center study included 262 consecutive (2008-2017) newborns who underwent the ASO. Demographic characteristics, echocardiography, and clinical outcomes were reviewed. Competing risk analysis modeled incidence of branch PA reintervention and cause-specific hazard regression for predictors analyses.
RESULTS: Median age and weight were 7 (range, 5-11) days and 3.4 (range, 3.1-3.8) kg, respectively. Various types of early branch PA reinterventions (concomitant revision or reintervention during the intensive care unit stay) were required in 28 (10.7%) patients. These patients had prolonged ventilation (P < .001), intensive care unit duration (P < .001), worse right ventricular function (P = .043), and high in-hospital mortality (P = .010). Branch PA dimensions significantly decreased immediately after ASO compared with baseline measurements. The median follow-up duration was 20.8 (range, 0.9-44.7) months. Branch PA reintervention was common among survivors without early reinterventions (9.4%), and even more frequent among those with early reinterventions (25%). Subsequent reintervention (all catheter-based) was necessary for more than one-third of patients after initial branch PA reintervention. The multivariable analysis showed preoperative dimension of the left PA (hazard ratio, 0.527 [95% CI, 0.337-0.823]; P = .005), and right PA (hazard ratio, 0.503 [95% CI, 0.318-0.796]; P = .003) were independently associated with late branch PA reinterventions.
CONCLUSIONS: Branch PA reintervention was common and often required surgical or catheter-based reinterventions after ASO. PA branch diameters became significantly smaller after ASO. Smaller preoperative branch PA predicted late branch PA reintervention, indicating a smaller margin of geometrical tolerance to this effect.
方法:回顾性单中心研究包括262名连续(2008-2017年)接受ASO的新生儿。人口特征,超声心动图,并对临床结果进行了回顾。竞争风险分析对分支PA再干预和特定原因风险回归的发生率进行建模,以进行预测分析。
结果:年龄和体重中位数为7(范围,5-11)天和3.4(范围,3.1-3.8)kg,分别。28例(10.7%)患者需要进行各种类型的早期分支PA再干预(在重症监护病房住院期间同时进行修正或再干预)。这些患者通气时间延长(P<.001),重症监护病房持续时间(P<.001),右心室功能较差(P=0.043),住院死亡率高(P=.010)。与基线测量相比,ASO后分支PA尺寸立即显着降低。中位随访时间为20.8(范围,0.9-44.7)个月。分支PA再干预在没有早期再干预的幸存者中很常见(9.4%),在早期再干预者中更为频繁(25%)。在初次分支PA再干预后,超过三分之一的患者需要随后的再干预(全部基于导管)。多变量分析显示左侧PA的术前维度(风险比,0.527[95%CI,0.337-0.823];P=.005),和右PA(危险比,0.503[95%CI,0.318-0.796];P=.003)与末梢分支PA再干预独立相关。
结论:分支PA再干预是常见的,在ASO后通常需要手术或基于导管的再干预。ASO后PA分支直径明显变小。较小的术前分支PA预测晚期分支PA再干预,表示此效果的几何公差余量较小。