Nuran ÜSTÜN, Dilek DİLLİ, Senem ÖZGÜR, Murat KOÇ, Aysegül ZENCİROĞLU, Serdar BEKEN, Nurullah OKUMUŞ

Kritik Konjenital Kalp Hastalıklı Yenidoğanlarda Kardiyak Girişim Sonrası Mortaliteyi Etkileyen Ana Risk Faktörleri

Amaç: Kritik konjenital kalp hastalıklı (KKH) yenidoğanlarda girişim sonrası mortaliteyi etkileyen risk faktörlerinin belirlenmesi amaçlandı.Gereç ve Yöntemler: Üçüncü düzey bir yenidoğan yoğun bakım ünitesinde (YYBÜ) Eylül 2010–Ocak 2012 tarihleri arasında izlenen ve girişim uygulanan kritik KKH tanılı 105 yenidoğan incelendi. Hastaların demografik verileri, girişim öncesi ve sonrası klinik bulguları, girişim tipi, Doğuştan Kalp Cerrahisi için Risk Ayarlanması sınıflamasına göre girişimsel risk skoru (Risk Adjustment in Congenital Heart Surgery; RACHS-1) ile ilgili veriler kaydedildi.Bulgular: Kardiyak girişim sırasında ortalama yaş 15.2±11.8 gündü. Transkateter girişim 29 (%27.6) hastada uygulandı. Toplam 76 hastaya (%72.4) kardiyak cerrahi girişim yapıldı. Girişim sonrası dönemde düşük kardiyak debi, pnömoni ve sepsis görülme sıklığı cerrahi girişim yapılan olgularda daha yüksekti. Bu hastalarda YYBÜ kalış süresi de daha uzundu. Mortalite oranı %35.2 (n=37) olarak bulundu. Transkateter girişim yapılan hastalarda mortalite daha düşüktü. Univaryant analizde ölen hastalarda gebelik haftasının daha düşük, prematürite oranının daha fazla, eşlik eden hastalık sıklığının daha yüksek, girişim öncesi mekanik ventilatörde kalma oranı, inotrop desteği, pulmoner hipertansiyon ve sepsis oranının daha fazla, cerrahi girişim gereksiniminin daha çok, girişim sırasındaki yaş ve RACHS-1 skorunun daha yüksek olduğu saptandı. Çoklu regresyon analizinde RACHS-1 skorunun yüksek olmasının mortalite ile ilişkili olduğu (Odds oranı: 4.5, %95 GA (1.5-13.1), p=0.005), gebelik yaşının büyük olmasının ise koruyucu bir faktör olduğu dikkati çekti (Odds oranı: 0.6, GA( %95) (0.5-0.9), p = 0.01).Sonuç: Bu çalışmada cerrahi girişim gereken kritik KKH’lı yenidoğanlar arasında mortalitenin yüksek olduğu, özellikle gebelik haftasının düşük, RACHS-1 skorunun ise yüksek olmasının mortalite riskini artırdığı sonucuna varıldı.

Anahtar Kelimeler:

Konjenital kalp hastalığı, Yenidoğan, Prematürite

Main Risk Factors for Mortality After Cardiovascular Interventions in Newborns with Critical Congenital Heart Diseases

Objective: It was aimed to define the main risk factors that affect mortality in infants with critical congenital heart disease (CHD).Material and Methods: We analyzed data from 105 infants with critical CHD underwent cardiovascular intervention at a tertiary neonatal intensive care unit (NICU) between September 2010 and January 2012. Demographic data, clinical findings (before and after intervention), type of intervention, and intervention risk score according to Risk Adjustment in Congenital Heart Surgery (RACHS-1) classification were evaluated. Results: The mean age at cardiovascular intervention was 15.2±11.8 days. Transcatheter interventions were performed in 29 patients (27.6%). Seventy-six patients (72.4%) underwent cardiovascular surgery. At post-interventional period, the rates of low cardiac output, pneumonia, and sepsis were significantly higher among patients underwent surgical intervention. Length of NICU stay was also longer among them. Overall mortality rate was 35.2% (n=37). Mortality was significantly lower in infants underwent transcatheter intervention. Univariate analyses showed that nonsurvivors differed from survivors in terms of gestational age, prematurity, the presence of associated disorder, pre-interventional need of mechanical ventilation, need of inotropic support, the presence of pulmonary hypertension and sepsis, requirement of cardiovascular surgery, age at intervention, and RACHS-1 score. Multivariate analysis showed that higher RACHS-1 score was associated with mortality (OR: 4.5, 95% CI (1.5-13.1), p=0.005) while higher gestational age was a preventive factor (OR: 0.6, 95% CI (0.5-0.9), p=0.01).Conclusion: Our study indicates that lower gestational age and severity of the disease seem to be most possible risk factors for mortality among infants with critical CHD

Keywords:

Congenital heart disease, Newborn, Prematurity,

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