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Survival into adulthood of patients with atrial isomerism undergoing cardiac surgery.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2015 Jun; Vol. 149 (6), pp. 1509-13. Date of Electronic Publication: 2015 Jan 24. - Publication Year :
- 2015
-
Abstract
- Objectives: To identify determinants of adverse outcomes in patients with atrial isomerism.<br />Methods: Determinants of survival were analyzed for the group as a whole as well as separately for left and right atrial isomerism.<br />Results: There were 78 cases with right and 104 with left atrial isomerism. Nineteen patients were not offered surgery; 49 (47%) of those with left atrial isomerism and 60 (77%) with right atrial isomerism were directed to single ventricle palliation. A total of 67 patients died. Survival to 25 years was 62% (95% confidence interval [CI], 53%-69%). Independent predictors of mortality were obstructed total anomalous pulmonary venous drainage (P < .001; hazard ratio [HR], 5.2; 95% CI, 2.7-9.7) and asplenia (P = .008; HR, 2; 95% CI, 1.2-3.3). There was no evidence that patients born in the recent era had improved survival (P = .47; HR, 1.1; 95% CI, 0.8-1.5). Survival was better for patients with left than right atrial isomerism: 18 years survival 74% (95% CI, 63%-82%) versus 50% (95% CI, 38%-60%). Independent predictors of mortality for patients with left atrial isomerism were dextrocardia (P = .009; HR, 3.0; 95% CI, 1.3-6.7) and pulmonary stenosis (P = .042; HR, 0.3; 95% CI, 0.1-0.9) and patients with right atrial isomerism, biventricular repair (P < .001; HR, 6.0; 95% CI, 2.8-13), and obstructed total anomalous pulmonary venous drainage (P < .001; HR, 4.2; 95% CI, 2.0-8.6).<br />Conclusions: A significant proportion of patients with isomerism still die before reaching adulthood. Only a fraction of those with obstructed pulmonary veins survive. Having biventricular repair does not confer a survival advantage to those born with right atrial isomerism.<br /> (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Cardiac Surgical Procedures adverse effects
Female
Heterotaxy Syndrome diagnosis
Heterotaxy Syndrome mortality
Hospitals, Pediatric
Humans
Kaplan-Meier Estimate
Male
Odds Ratio
Palliative Care
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Victoria
Abnormalities, Multiple
Cardiac Surgical Procedures mortality
Heterotaxy Syndrome surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 149
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25752370
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2015.01.038