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Patients with Congenital Systemic-to-Pulmonary Shunts and Increased Pulmonary Vascular Resistance: What Predicts Survival after Operation?

Hui-Li Gan

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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

BACKGROUNDThis 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/RESULTS1024cases 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.

CONCLUSIONAPVRIO < 10.3 WU.m2and PVRID > 7.3 WU.m2on 100% oxygen suggests that closure of congenital septal defects can be undertaken with acceptable risk.