| Background:Tetralogy of Fallot(TOF)is the most common cyanotic congenital heart disease.Absolute lymphocyte count(ALC)is a low-cost and easy-to-obtain inflammatory indicator;however,its association with the prognosis of patients with TOF remain unknown.This study aimed to determine the prognostic value of preoperative ALC in children with TOF.Methods and Results:This retrospective study included 707 patients younger than 6 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital,China.The endpoints were mortality,ECMO placement,postoperative hospital stay>30 days,and severe postoperative complications;patients were grouped based on prognosis:poor prognosis(n=76)and good prognosis(n=631).Univariable and multivariable logistic regression analyses were performed to identify the independent risk factors for poor prognosis,on which a risk scoring system was based.The receiver operating characteristic curve was used to assess model performance.Using another model without ALC,the effect of the addition of ALC was assessed.Results suggested that ALC was an independent factor with a cutoff point of 4.36×109/L.The addition of ALC improved the AUC from 0.771 to 0.781(P<0.001).To avoid reverse causality and further control for confounding factors,the patients were further divided based on ALC level,and a propensity score matching was performed;117 paired patients were identified for further analysis.Low ALC levels had an OR of 3.500(95%CI,1.413-8.672).Conclusions:Low preoperative ALC represents an independent predictor of poor prognosis in children with TOF.Background:As an easily accessible and intervened clinical indicator,preoperative oxygen saturation(SpO2)is an important factor affecting the prognosis of patients with tetralogy of Fallot(TOF).However,whether SpO2 is associated with postoperative prolonged mechanical ventilation(PMV)remains unknown.Therefore,this study aimed to investigate the impact of preoperative SpO2 on postoperative PMV in children with TOF.Methods and Results:This retrospective study enrolled 617 patients aged<18 years who underwent repair of TOF between 2016 and 2018 in Fuwai Hospital,China.The main outcome was PMV,and the secondary outcomes included mechanical ventilation(MV)time,length of ICU stay,length of postoperative hospital stay,length of hospital stay,and hospitalization cost.PMV was defined as MV support time≥48h,and the subjects were first divided into PMV and non-PMV groups.By univariate and multivariate logistic regression,SpO2 was identified as an independent risk factor for PMV(OR,0.968;95%CI,0.948-0.989;P=0.003),and the area under the receiver operating characteristic curve was calculated to determine the cut-off value of SpO2,which was 85%.Then,subjects were further grouped on the basis of the level of SpO2(SpO2>85%or SpO2≤85%),and propensity score matching(PSM)analysis was conducted to reduce the influence of potential confounders.According to the outcomes of 213 paired patients after PSM,the incidence of PMV was significantly higher in patients with lower preoperative SpO2 level(P=0.005).Moreover,there were also significant increases in mechanical ventilation time,length of ICU stay,length of postoperative hospital stay,length of hospital stay,and hospitalization cost.Conclusions:Low preoperative SpO2 represents an independent risk factor of postoperative PMV in children with TOF.Background:Preoperative low oxygen saturation can lead to significantly prolong postoperative mechanical ventilation time,and previous studies have also shown that preoperative chronic hypoxia(CH)can aggravate lung ischemia-reperfusion injury(LIRI)after cardiac surgery.Therefore,this study intends to clarify the influence from basic science research perspective,and to explore the possible mechanism.Methods and Results:This study was conducted both at the animal and cellular levels.At the animal level,SD rats were housed in normoxia(21%O2)or CH(10%O2)for 2 weeks to build the normoxic control group and the CH group,and the LIRI model was constructed by simulating cardiopulmonary bypass(CPB)operation.Then compare the lung injury of the two groups,and explore the possible molecular mechanisms through proteomic analysis.Human pulmonary microvascular endothelial cells and A549 cells were selected to observe the damage of pulmonary microvascular endothelial cells and alveolar epithelium respectively.CH and LIRI were simulated by hypoxic culture and hypoxic reoxygenation model respectively,and the damage condition in CH group and control group was compared.The results showed that compared with the control group,long-term CH before surgery will aggravate the LIRI after surgery,presenting with increased apoptosis of lung tissue cells,neutrophil infiltration,increased interstitial exudate,pulmonary edema and alveolar collapse.The permeability of pulmonary microvascular endothelium and alveolar epithelium was impaired,and the cytoskeleton was disturbed.According to proteomic results,this may be due to the up-regulation of EGFR expression caused by CH,which aggravates the inflammatory response and leads to impaired lung barrier function.Conclusions:Long-term CH leads to impaired lung barrier function and aggravates LIRI after cardiac surgery,which may be caused by up-regulation of EGFR expression.Tetralogy of Fallot(TOF)is the most common cyanotic congenital heart disease.With the constant refinement of surgical technique and the optimization of perioperative management in recent years,both the perioperative and long-term mortality of TOF have been greatly improved.Therefore,more and more studies have started to focus on the postoperative complications.Understanding postoperative complications and their risk factors is important to improve perioperative management,reduce hospital stay and medical costs,and improve the overall prognosis.Therefore,this review will summarize the postoperative complications of TOF and their management strategies,hoping to provide more reliable evidence for the perioperative management of TOF patients. |
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