The Prevalence and Impact of Congenital Diaphragmatic Hernia Among Patients Undergoing Surgery for Congenital Heart Disease

被引:9
作者
Fraser, Charles D., III [1 ]
Hill, Kevin D. [2 ,3 ]
Wallace, Amelia [2 ,3 ]
Chiswell, Karen [2 ,3 ]
Zhou, Xun [1 ]
Jelin, Eric B. [3 ]
Kays, David [4 ]
Jacobs, Jeffrey P. [5 ]
Hibino, Narutoshi [1 ]
Jacobs, Marshall L. [1 ]
Vricella, Luca A. [1 ]
机构
[1] Johns Hopkins Univ Hosp, Div Cardiac Surg, 1800 Orleans,Zayed Tower 7107, Baltimore, MD 21287 USA
[2] Duke Univ, Duke Clin Res Inst, Durham, NC USA
[3] Johns Hopkins Univ Hosp, Div Pediat Surg, Baltimore, MD 21287 USA
[4] Johns Hopkins All Childrens Hosp, Div Pediat Surg, St Petersburg, FL USA
[5] Johns Hopkins All Childrens Hosp, Div Cardiovasc Surg, St Petersburg, FL USA
关键词
Congenital diaphragmatic hernia; Congenital heart disease; Pediatrics; GENETIC ABNORMALITIES; OUTCOMES; SOCIETY; MALFORMATIONS; OPERATIONS; MORBIDITY;
D O I
10.1053/j.semtcvs.2018.09.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
There has not been a multicenter investigation to elucidate the prevalence and impact of congenital diaphragmatic hernia (CDH) on children undergoing cardiac surgery. We investigated the prevalence of CDH across congenital cardiac diagnostic and procedural groups and its impact on outcomes. The STS Congenital Heart Surgery Database was queried to identify children undergoing cardiac surgery who also had CDH. Baseline perioperative characteristics and postoperative outcomes were compared between groups. Subgroup analyses were performed based on case complexity as determined by STAT Categories. Overall 426 of 157,419 (0.27%) pediatric patients undergoing an index cardiac operation had a diagnosis of CDH including 89 neonates (0.25% of all neonatal index operations), 217 infants (0.39%), and 120 children (0.18%). The frequency of concomitant CDH varied across diagnostic groups and, in neonates and infants, was highest for tetralogy of Fallot (0.45%, n = 41), coarctation (0.39%, n = 27) and complete atrioventricular septal defects (0.31%, n = 19). For neonates and infants outcomes were generally worse in CDH vs no-CDH patients across the various procedural strata. For example, STAT ≥3 operative mortality was 34.4% vs 10.3% (P < 0.001) for neonates, and 24.2% vs 5.3% (P < 0.001) for infants with vs without CDH, respectively. In older children, outcomes disparities were less clear cut with no significant differences in mortality, and variable differences for complication and length of stay outcomes. CDH occurs in a small percentage of patients born with congenital heart disease. Concomitant diagnosis of CDH portends increased morbidity and mortality in infants and neonates undergoing cardiac surgery. © 2018 Elsevier Inc.
引用
收藏
页码:69 / 77
页数:9
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