4
|
Takai A, Yamagishi M, Ikeda K, Sugimoto A, Ichise E, Maeda Y, Teramukai S, Hasegawa T, Oda S, Iehara T. Effectiveness of cardiac palliative surgery for trisomy 18 patients with increased pulmonary blood flow. Am J Med Genet A 2023; 191:2703-2710. [PMID: 37698299 DOI: 10.1002/ajmg.a.63401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
Congenital heart disease (CHD) is common among patients with trisomy 18 (T18), but cardiac surgery has been rarely indicated for T18 patients due to their short life span. Although the therapeutic effects of aggressive interventions were recently demonstrated for T18 patients, the subjects and factors examined varied, resulting in inconsistent findings. Therefore, the effects of cardiac surgery for T18 remain unclear. We herein investigated the outcomes of cardiac palliative surgery for CHD with increased pulmonary blood flow in T18 patients. 27 patients were examined: 13 (48.1%) underwent cardiac palliative surgery and 14 (51.9%) did not. Median survival times in the no-surgery and surgery groups were 223.0 days (95% confidence interval [CI]: 46-361 days) and 723.0 days (95% CI: 360-1447 days), respectively. The number of patients with pulmonary hypertension significantly differed between the two groups (5 of 14 in the no-surgery group and 0 in the surgery group). Five of 14 patients in the no-surgery group and 10 of 13 in the surgery group were discharged to home care (odds ratio: 10.8 [95% CI: 1.07-110.0]). Therefore, cardiac palliative surgery may be used to treat CHD with increased pulmonary blood flow in T18 patients.
Collapse
Affiliation(s)
- Akari Takai
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Pediatrics, Hananoki Medical Welfare Center, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyuki Ikeda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuya Sugimoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Eisuke Ichise
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuji Hasegawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
6
|
Chida-Nagai A, Masaki N, Maeda K, Sasaki K, Sato H, Muneuchi J, Ochiai Y, Murayama H, Tahara M, Shiono A, Shinozuka A, Kono F, Machida D, Toyooka S, Sugimoto S, Nakamura K, Akagi S, Kondo M, Kasahara S, Kotani Y, Koizumi J, Oda K, Harada M, Nakajima D, Murata A, Nagata H, Yatsunami K, Kobayashi T, Matsunaga Y, Inoue T, Yamagishi H, Nakagawa N, Ohtani K, Yamamoto M, Ito Y, Hokosaki T, Kuwahara Y, Masutani S, Nomura K, Wada T, Sawada H, Abiko M, Takahashi T, Ishikawa Y, Okada S, Naitoh A, Toda T, Ando T, Masuzawa A, Hoshino S, Kawada M, Nomura Y, Ueno K, Ohashi N, Tachibana T, Cao Y, Ueda H, Yanagi S, Koide M, Mitsushita N, Higashi K, Minosaki Y, Hayashi T, Okamoto T, Kuraishi K, Ehara E, Ishida H, Horigome H, Murakami T, Takei K, Ishii T, Harada G, Hirata Y, Maeda J, Tatebe S, Ota C, Hayabuchi Y, Sakazaki H, Sasaki T, Hirono K, Suzuki S, Yasuda M, Takeda A, Sawada M, Miyaji K, Kitagawa A, Nakai Y, Kakimoto N, Agematsu K, Manabe A, Saiki Y. Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease. Front Cardiovasc Med 2023; 10:1212882. [PMID: 37731527 PMCID: PMC10507182 DOI: 10.3389/fcvm.2023.1212882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Aims Limited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH. Methods This retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death. Results The 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45-13.73; P = .009). Conclusions The IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kay Maeda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Konosuke Sasaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University, Yufu, Japan
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hiroomi Murayama
- Department of Cardiovascular Surgery, Aichi Children’s Health and Medical Center, Obu, Japan
| | - Masahiro Tahara
- Department of Pediatrics, Tsuchiya General Hospital, Hiroshima, Japan
| | - Atsuko Shiono
- Department of Pediatric Cardiology, Ibaraki Children’s Hospital, Mito, Japan
| | - Atsushi Shinozuka
- Department of Pediatrics, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Fumihiko Kono
- Department of Diagnostic Pathology, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Daisuke Machida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Maiko Kondo
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University, Okayama, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Yahaba, Japan
| | - Katsuhiko Oda
- Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masako Harada
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Murata
- Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Yatsunami
- Department of Pediatric Cardiology, Kumamoto City Hospital, Kumamoto, Japan
| | - Tomio Kobayashi
- Division of Cardiology, Gunma Children’s Medical Center, Shibukawa, Japan
| | - Yoshikiyo Matsunaga
- Department of Cardiovascular Surgery,Gunma Children’s Medical Center, Shibukawa, Japan
| | - Takahiro Inoue
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakagawa
- Department of Pediatric Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Katsuki Ohtani
- Department of Pediatric Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsunori Hokosaki
- Department of Pediatric Cardiology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuta Kuwahara
- Department of Pediatric Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Koji Nomura
- Department of Pediatric Cardiovascular Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Tsutomu Wada
- Department of Pediatrics, School of Medicine Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Sawada
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Abiko
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tatsunori Takahashi
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuichi Ishikawa
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Atsushi Naitoh
- Department of Neonatology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Takako Toda
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Ando
- Department of Paediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Masuzawa
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Hoshino
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Masaaki Kawada
- Department of Cardiac Surgery, Section of Pediatric and Congenital Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Kentaro Ueno
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Chukyo Children Heart Centre, Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Yuchen Cao
- Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Hideaki Ueda
- Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Sadamitsu Yanagi
- Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Masaaki Koide
- Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Norie Mitsushita
- Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan
| | - Kouji Higashi
- Division of Cardiology, Chiba Children's Hospital, Chiba, Japan
| | - Yoshihiro Minosaki
- Neonatal Intensive Care Unit, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Tomohiro Hayashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Okamoto
- Department of Cardiac Surgery, Daiyukai General Hospital, Ichinomiya, Japan
| | - Kenji Kuraishi
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Hidekazu Ishida
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Murakami
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children’s Hospital, Azumino, Japan
| | - Taku Ishii
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Harada
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yasutaka Hirata
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Maeda
- Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Yasunobu Hayabuchi
- Department of Pediatrics, School of Medicine, University of Tokushima, Tokushima, Japan
| | - Hisanori Sakazaki
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takashi Sasaki
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Sayo Suzuki
- Department of Cardiology, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Masahiro Yasuda
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Madoka Sawada
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsushi Kitagawa
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Nakai
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Kouta Agematsu
- Departmentof Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
7
|
Tamaki S, Iwatani S, Izumi A, Hirayama K, Kataoka D, Ohyama S, Ikuta T, Takeoka E, Matsui S, Mimura H, Minamikawa S, Nakagishi Y, Yoshimoto S, Nakao H. Improving survival in patients with trisomy 18. Am J Med Genet A 2021; 188:1048-1055. [PMID: 34889030 DOI: 10.1002/ajmg.a.62605] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/30/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
The effects of medical and surgical interventions on the survival of patients with trisomy 18 have been reported, leading to changes in perinatal management and decision-making. However, few studies have fully reported the recent changes in survival and treatment of trisomy 18. We examined how treatment and survival of patients with trisomy 18 have changed over a decade in a Japanese pediatric tertiary referral center. This retrospective cohort study included patients with trisomy 18 who were admitted within the first 7 days of life at the Hyogo Prefectural Kobe Children's Hospital between 2008 and 2017. The patients were divided into early period (EP) and late period (LP) groups based on the birth year of 2008-2012 and 2013-2017, respectively. Changes in treatment and survival rates were compared between the two groups. A total of 56 patients were studied (29 in the EP group and 27 in the LP group). One-year survival rates were 34.5% and 59.3% in the EP and LP groups, respectively. The survival to discharge rate significantly increased from 27.6% in the EP group to 81.5% in the LP group (p < 0.001). The proportion of patients receiving surgery, especially for congenital heart defects, significantly increased from 59% in the EP group to 96% in the LP group (p = 0.001). In our single-center study, survival and survival to discharge were significantly improved in patients with trisomy 18, probably because of increased rate of surgical interventions. These findings may facilitate better decision-making by patients' families and healthcare providers.
Collapse
Affiliation(s)
- Shoko Tamaki
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Sota Iwatani
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Ayako Izumi
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Kentaro Hirayama
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Dai Kataoka
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Shohei Ohyama
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Toshihiko Ikuta
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Emiko Takeoka
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Sachiko Matsui
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Hitomi Mimura
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Shogo Minamikawa
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yasuo Nakagishi
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Seiji Yoshimoto
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Hideto Nakao
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| |
Collapse
|