Conference: 2012 International PHA Conference and Scientific Sessions
Release Date: 06.22.2012
Presentation Type: Abstracts
Hui-Li Gan, MD,PhD
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029 China
BACKGROUND: This study was designed to investigate the relative efficacy of preoperative pulmonary vascular resistance index (PVRI),pulmonary to systemic flow ratio (Qp:Qs),ratio of pulmonary and systemic vascular resistance (Rp:Rs),pulmonary vascular resistanc eindex on pure oxygen challenge (PVRIO), and the difference between PVRI and PVRIO (PVRID)to predict in-hospital death, late death, and total death after the shunt closure procedure for patients with a congenital systemic-to-pulmonary shunt and advanced pulmonary hypertension (PAH) beyond infancy and early childhood.
METHODS/RESULTS: 1024cases of congenital systemic-to-pulmonary shunt and advanced pulmonary hypertension beyond infancy and early childhood were closed surgically. There were a total of 61 in-hospital deaths after the shunt closure procedure, and the surgical mortality was 5.96% (61/1024). With a mean follow up of 8.5±5.5 (range 0.7 to 20) years, there were 46 late deaths, yielding 107 total deaths. In order to predict in-hospital death and total death, PVRI, PVRIO, PVRID, Qp:Qs, Rp:Rs were chosen as individual lrisk predictors. Receiver operating characteristic curves were used to evaluate the corresponding balance between sensitivity and specificity over a range of their values. The results show that these individual factors are all predictors for predicting in-hospital death and total death but that PVRIO shows better performance than the other risk factors, and PVRIO < 10.3 WU.m2 and PVRID > 7.3 WU.m2 best predicted survival.
CONCLUSION: APVRIO < 10.3 WU.m2and PVRID > 7.3 WU.m2on 100% oxygen suggests that closure of congenital septal defects can be undertaken with acceptable risk.