2023年 · 第103卷第32期

Perioperative prophylactic use of glucocorticoids has been done for decades, but it is unclear whether it can improve outcomes in infants following cardiac surgery with cardiopulmonary bypass. The study was a registry-based multicenter, prospective, randomized controlled trial that included 1 263 infants undergoing cardiac surgery with extracorporeal circulation (age<1 year old) were randomized into two groups, one supplemented with methylprednisolone (30 mg/kg) in the extracorporeal circulation prefill and the other supplemented with placebo in the prefill. Differences between the two groups were judged by graded composite outcomes such as surgical death, heart transplantation during hospitalization, any of the 13 major complications, or length of postoperative hospital stay. The findings found that there was no statistically significant difference in the likelihood of a worse outcome between the methylprednisolone and placebo groups among 1 200 infants treated with methylprednisolone (599 infants) or placebo (601 infants) (adjustedOR=0.86，95%CI：0.71~1.05，P=0.140）。 After adjusted analysis, the methylprednisolone group had worse outcomes compared to the placebo group.OR=0.82（95%CIAlthough this result suggests that methylprednisolone may be beneficial in improving postoperative outcomes in infants, children in the methylprednisolone group were more likely to have postoperative hyperglycemia and receive insulin than in the placebo group (19.0% vs. 6.7%,P<0.001）。 Therefore, it is concluded that for infants undergoing cardiac surgery with cardiopulmonary bypass, perioperative prophylactic use of methylprednisolone does not show significant advantages over no use of methylprednisolone in terms of surgical death, heart transplantation during hospitalization, complication occurrence, and length of postoperative hospitalization, and that children with perioperative prophylactic use of methylprednisolone are more likely to develop postoperative hyperglycemia.

In children with severe pulmonary hypertension, the inclusion of Potts shunt in an integrated response strategy may improve the outcome of medical treatment and delay lung transplantation, but there is insufficient evidence to support this decision. The study included and prospectively analyzed 23 children (20 surgical, 3 transcatheter) who underwent Potts shunt and 31 who underwent lung transplantation from 1995 to the present. The results showed that all children who underwent Potts shunt, despite receiving maximum medical therapy, experienced a significantly higher right ventricular pressure than systemic pressure. At mechanical ventilation time (1.3 d vs. 10.2 d,P=0.019), median length of stay (9.8 d vs. 34.0 d,P=0.012) and overall complication rate [35% (7/20) vs 81% (25/31),P=0.003], perioperative outcomes after Potts shunt were better than lung transplantation. Further studies showed that surgical mortality after Potts shunt was higher (20%, 4/20) than lung transplant mortality (6%, 2/31,P=0.195), and risk factors for this outcome included preoperative extracorporeal membrane oxygenation and significant right ventricular dysfunction. At the interim follow-up (median 1.8 years, maximum 6.1 years), the improvement of right ventricular/left ventricular pressure and functional status in patients undergoing Potts shunt was better than that in patients undergoing lung transplantation, and there was no significant difference in survival rate between the two (P=0.258）。 Therefore, it is concluded that Potts shunt is an effective method to relieve hypersystemic pulmonary hypertension in children, and it is one of the strategies to maximize the prolongation of children's life span and improve the functional state of the body.