Operation-effect analysis of surgical repair combined with collateral embolization for cyanotic congenital heart disease with major aortopulmonary collateral arteries / 中华胸心血管外科杂志

ABSTRACT

Objective To evaluate the operation-effect of surgical repair combined with collateral embolization for cyanotic congenital heart disease with major aortopulmonary collateral arteries (MAPCAs) and optimal time of the associated operation. Methods We retrospectively reviewed the clinical data of 151 patients with cyanotic congenital heart disease and MAPCAs from 1992 to Nov of 2009. Two hundred and fifty two MAPCAs were embolized. One hundred and thirty two patients were performed one-stage surgical correction, another 19 patients received palliative operation and 7 patients received staging surgical repair after palliative operation. Results All patients received combined therapy of MAPCAs embolization and surgical repair with total in-hospital mortality of 7.3%. There was no death in 6 cases of preoperative interventional embolization, 2 death in 6 cases of postoperative embolization before July 2007 and none after July 2007. Simultaneous hybrid procedures (4.3%) had lower in-hospital mortality than intraoperative embolization before July 2007 (21.1%). There were significant differences regarding the duration of respirator usage, duration of ICU and postoperative hospital stay, as well as the cost of hospitalization for the preoperative, intraoperative and postoperative embolization groups ( P = 0.000, 0.000 and 0.000, respectively). Patients had a shorter duration of ICU and hospital stay after July 2007 ( P = 0.002, 0.002 ). The duration of ICU and hospital stay in simultaneous hybrid procedures was shorter than those of intraoperative embolization before July 2007 (5.37 days vs. 8.38 days, P=0.079 and 13.01 days vs. 18.74 days, P=0.059, respectively). Conclusion The surgical volume of the associated opertaion increased rapidly since the establishment of hybrid operating room. Simultaneous hybrid surgery significantly reduced the operative mortality, shortened the duration of ICU and hospital stay, and improved the operation-effect. Preoperative and intraoperative embolization could alleviate operative injury, reduce respirator usage, shorten the duration of PICU and hospital stay. Therefore, the cost of hospitalization was reduced. Postoperative embolization was a good compensate procedure for decreasing operative complications.