Abstract
Introduction. The mortality rate in children first year of life with coarctation of the aorta (CoAo) is maintained at from 2 to 17% at different
of disease associated. The purpose of this study was to identify factors of risk of death in patients 1 year of life with CoAo.
Material and methods. Conducted a retrospective analysis of 853 histories of diseases of children in the first year of life with CoAo
with biventricular hemodynamics without hemodynamically significant ventricular septal defect (up to 4 mm) and concordance atrioventricular
and ventricular-arterial connections received by A.N. Bakoulev Scientific Center for Cardiovascular Surgery for the period
from 2005 to 2015. Was a statistical analysis of 123 factors.
Results. It was found that the probability of death is higher (р=0.0001) in patients aged less than 13.5 days of life (odds ratio
(OR) 0.08); weighing less than 2.3 kg (OR 0.08); Z-score mitral valve (ZMV) below –2.9 (OR 0.10); Z-score aortic valve (ZAV) less
of –1.6 (OR 0.11); Z-score left ventricle (LV) end diastolic size (ZEDS) below –4 (OR 0.05); the pressure gradient on the isthmus of
the aorta below 50 mmHg (OR 0.09); the size of the patent ductus arteriosus more than 2.8 mm (OR 0.41); pressure in right ventricle
over 46.5 mmHg (OR 0.33); insufficiency of the tricuspid valve over 1 degree (OR 0.33). Among qualitative values of significant
importance was the neonatal period (р=0.0001, OR 0.06), mechanical ventilation in connection with the development of the critical
state (р=0.0001, OR 0.05), the critical state at admission (р=0.0001, OR 0.17), admission to mechanical ventilation
(р=0.0001, OR 0.12), ventilation in anamnesis (р=0.019, OR 0.43), presence of genetic syndrome in the baby (р=0.01, OR 0.29),
the presence of malformations of other organ systems (р=0.05, OR 0.29), intrauterine infection of the fetus (р=0.024, OR 0.91), balloon
dilatation of aortic valve (р=0.046). High prognostic significance of the severity of the condition and the neonatal period. In the
evaluation of postoperative complications risk factors for fatal outcome with high confidence (р=0.0001) was the disseminated
intravascular coagulation (mortality 100%), the systemic inflammatory response syndrome (the mortality rate of 72.7%, OR 0.01),
Necrotizing enterocolitis (mortality of 66.7%, OR 0.006), acute renal failure (mortality of 66.7%, OR 0.016), pneumonia (mortality
rate of 34.5%, OR 0.076), acute pulmonary insufficiency (case fatality rate of 22.1%, OR 0.111) acute heart failure (the case fatality
rate of 15.8%, OR 0.083), cerebral vascular accident, brain swelling, hydropericardium, and, with certainty р=0.015, – pneumothorax.
Identified risk factors for death among newborns was significantly weight less than 2.8 kg (р=0.0001, OR 0.22), ZMV below
–2.4 (р=0.04, OR 0.37), ZAV less of –1.6 (р=0.001, OR 0.237), ZEDS below –3 (р=0.0001, OR 0.159).
Conclusion. The main risk factors in patients with CoAo are critical the patient's condition before surgery, hypoplasia of left heart
structures, the age of 13.5 days of life and weigh less than 2.3 kg. In the group of newborn with weight less than 2.8 kg, ZMV below
–2.4 (р=0.04, OR 0.37), ZAV less of –1.6 (р=0.001, OR 0.237), ZEDS below –3 (р=0.0001, OR 0.159).
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