Risk factors for adverse perioperative outcomes following biventricular repair in children with pulmonary atresia with intact ventricular septum
CHEN Shuo
ZHOU Zi-qin
ZHANG Ru-yue
CHEN Wei-min
HU Luo-ming
WU Jia-xiong
TIAN Miao
SU Zhan-hao
ZHANG Yong
LI Xiao-hua
WEN Shu-sheng
CHEN Ji-mei
Abstract：Objective To identify independent risk factors for perioperative adverse outcomes in patients with pulmonary atresia with intact ventricular septum(PA/IVS)who underwent biventricular repair,and to develop a visualized risk assessment model to support clinical decision-making.Methods This retrospective cohort study included 97 PA/IVS patients who underwent biventricular repair at Guangdong Provincial People's Hospital from June 1999 to June 2024.Patients were categorized into two groups:those with adverse outcomes(n=27)and those with normal outcome groups(n=70).Variables analyzed included gestational age,birth weight,tricuspid valve Z-score,right ventricular dimensions,and intraoperative parameters.Logistic regression analysis and ROC curves were utilized to identify risk factors and evaluate predictive performance.Results The cohort comprised 97 children with PA/IVS who underwent biventricular repair.The average gestational age and right ventricular transverse diameter in the adverse outcome group were significantly lower than those in the favorable outcome group[(36.2±2.6)weeks vs.(38.7±2.0)weeks,(11.9±2.5)mm vs.(14.4±4.7)mm,P<0.05].Additionally,the incidence of intraoperative aortic cross-clamping was higher in the adverse outcome group(74.1%vs.51.4%).Multivariate analysis identified three independent risk factors for short-term adverse outcomes:shorter gestational age(OR=0.555,95%CI 0.395-0.782,P=0.001),narrower right ventricular transverse diameter(OR=0.751,95%CI 0.614-0.912,P=0.004),and aortic cross-clamp(OR=5.18,95%CI 1.322-19.734,P=0.018).The nomogram created from these variables demonstrate excellent predictive ability(AUC=0.885),with gestational age being the strongest predictor(AUC=0.821).Conclusions For PA/IVS patients undergoing biventricular repair,shorter gestational age,narrower right ventricular transverse diameter,and aortic cross-clamp are significant predictors of adverse short-term outcomes.This risk assessment model provides evidence-based support for short-term postoperative risk stratification,optimization of surgical timing,and prevention of complication in PA/IVS patients.
Keywords：Pulmonary Atresia with Intact Ventricular SeptumBiventricular repairRisk factorsPrognosis
Publication Date：2026-01-25
Online Publishing Date：2026-02-04(First online date of this platform, not the publication date of the document)
Pages：8( 16-23 )