Background: High rates of mortality and aortic arch stenosis have been reported for one-stage radical surgery of interruption of aortic arch (IAA) with ventricular septal defect (VSD) and other associated intracardiac defects, but the sample size of the study is relatively small, and the credibility of the study is not high. The risk factors of death and aortic arch stenosis will be analyzed in a large sample size of infants with IAA, VSD and other associated intracardiac defects after one-stage radical resection. Methods: A retrospective analysis was performed on 152 children with IAA, VSD and other associated intracardiac defects from January 2006 to January 2017 who had undergone one-stage radical resection, including 95 cases of type A and 57 cases of type B. January 2006–December 2011 as the early period, and January 2012–January 2017 as the late period. Cox proportional hazards regression model was used to analyze the risk factors for mortality and aortic arch stenosis after surgery, the overall survival rate was analyzed by the Kaplan-Meier method, and the survival curve was drawn by GraphPad Prism 8 software. Results: 22 cases (14.47%) died, 27 cases (17.76%) developed aortic arch stenosis. The 1-month, 3-month, 6-month, 1-year, 3-year, and 5-year survival rates were 85.53%, 85.53%, 85.53%, 84.21%, 78.95% and 75.66%, respectively. Low age (Hazard Ratio (HR) = 0.551, 95% Confidence Interval (CI): 0.320–0.984, p = 0.004), low body weight (HR = 0.632, 95% CI: 0.313–0.966, p = 0.003), large ratio of VSD diameter/aortic diameter (VSD/AO) (HR = 2.547, 95% CI: 1.095–7.517, p = 0.044), long duration of cardiopulmonary bypass (HR = 1.374, 95% CI: 1.000–3.227, p = 0.038), and left ventricular outflow tract obstruction (LVOTO) (HR = 3.959, 95% CI: 1.123–9.268, p = 0.015) were independent risk factors for postoperative death. The surgical period (January 2006–December 2011) (HR = 0.439, 95% CI: 0.109–0.964, p = 0.046) and the addition of pericardial anastomosis to the anterior aortic wall (HR = 0.398, 95% CI: 0.182–0.870, p = 0.021) were independent risk factors for postoperative aortic arch stenosis. Conclusions: Children with low age, low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOTO, the surgical period (January 2006–December 2011) and pericardial anastomosis with anterior aortic wall have poor prognosis.
Background: To analyze the risk factors of death and aortic stenosis (AS) in infants with interruption of aortic arch (IAA) combined with ventricular septal defect (VSD).Methods: A retrospective analysis was performed on 152 children with IAA combined with VSD who were admitted to our hospital from January 2006 to January 2022, including 85 cases of type A, 57 cases of type B and 10 cases of type C, and who had undergone one-stage radical surgery. Cox proportional hazards regression model was used to analyze the risk factors of death and AS after one-stage radical resection. Kaplan-Meier method was used to analyze postoperative overall survival rate, and R software was used to draw survival curve. Results: Of all patients, 22 cases (14.47%) died after surgery, and 27 cases (17.76%) experienced AS. The 1-month, 3-month, 6-month, 1-year, 2-year, 3-year, 4-year, and 5-year survival rates were 94.06%, 94.06%, 90.10%, 88.12%, 86.80%, 86.14%, 86.14% and 85.48%, respectively.Low body weight (P=0.004), large ratio of VSD diameter/diameter of aortic root (VSD/AO) (P=0.008), long duration of cardiopulmonary bypass (P=0.002), long hypothermic circulatory arrest (P=0.036), the period of surgery (from January 2006 to December 2013) (P= 0.038), and left ventricular outflow tract (LVOT) obstruction (P=0.000) were related risk factors for postoperative mortality. Of these, low body weight ( P = 0.004 ), large ratio of VSD/AO ( P = 0.044 ), long duration of cardiopulmonary bypass (P = 0.044), and combined LVOT (P = 0.000) were independent risk factors for postoperative mortality. The time of surgery (from January 2006 to December 2013) (P=0.046), and the addition of anastomosis with autologous pericardium to the anterior aortic wall (P=0.015) were associated risk factors for postoperative AS, and the latter (P=0.021) was the independent risk factor for postoperative AS. Conclusions: The mortality and AS rate are still high in infants with IAA and VSD after one-stage radical surgery. Patients with low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOT and anastomosis with autologous pericardium to the anterior aortic wall have poor prognosis.
Background To analyze the risk factors of death and aortic stenosis (AS) in infants with interruption of aortic arch (IAA) and ventricular septal defect (VSD) after one-stage radical resection. Methods A retrospective analysis was performed on 152 children with IAA and VSD from January 2006 to January 2017 who had undergone one-stage radical resection, including 95 cases of type A and 57 cases of type B. Cox proportional hazards regression model was used to analyze the risk factors for mortality and AS after surgery, the overall survival rate was analyzed by the Kaplan-Meier method, and the survival curve was drawn by GraphPad Prism 8 software. Results 22 cases (14.47%) died, 27 cases (17.76%) developed AS. The 1-month, 3-month, 6-month, 1-year, 3-year, and 5-year survival rates were 85.53%, 85.53%, 85.53%, 84.21%, 78.95% and 75.66%, respectively. Low age (P = 0.004), low body weight (P = 0.003), large ratio of VSD diameter/aortic diameter (VSD/AO) (P = 0.044), long duration of cardiopulmonary bypass (P = 0.038), and left ventricular outflow tract obstruction (LVOTO) (P = 0.015) were independent risk factors for postoperative death. The surgical period (from January 2006 to December 2011) (P = 0.046) and the addition of pericardial anastomosis to the anterior aortic wall (P = 0.021) were independent risk factors for postoperative AS. Conclusions Children with low age, low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOTO, the surgical period (from January 2006 to December 2011) and pericardial anastomosis with anterior aortic wall have poor prognosis.
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