[The actuarial survival analysis to the surgical and non-surgical therapy regime for congenital heart disease with severe pulmonary hypertension].
OBJECTIVE
To investigate the relationship between the long-term outcomes of surgical treatment and preoperative pulmonary vascular resistance (PVR) or pulmonary to systemic flow ratio (Qp/Qs) in patients of congenital heart diseases with severe pulmonary hypertension (CHDSPH).


METHODS
From February 1990 to July 2008, 1212 cases of CHDSPH were treated non-surgically or surgically and were retrospectively classified as non-surgical group (n = 297) and surgical group (n = 915). Propensity score of inclusion into the surgical group were estimated and 245 tribes were get with the same propensity score +/- 0.05. The Kaplan-Meier survival curves were constructed for the 245 tribes with the PVR stratum at the level of 120 kPa x L(-1) x S(-1) or with the Qp/Qs stratum at the level of 1.25.


RESULTS
With the follow-up of 97 +/- 57 months, there were 44 late deaths in the surgical group and 65 late deaths in the non-surgical group. In the 245 propensity score matched tribes, the Log rank test between non-surgical group and surgical group revealed chi(2) = 0.54, P = 0.4611 for the stratum of PVR > or = 120 kPa x L(-1) x S(-1), and chi(2) = 51.68, P = 0.000 for stratum of PVR < 120 kPa x L(-1) x S(-1); the Log rank test between non-surgical group and surgical group revealed chi(2) = 0.97, P = 0.3254 for the stratum of Qp/Qs < 1.25, and chi(2) = 62.77, P = 0.000 for stratum of Qp/Qs > or = 1.25.


CONCLUSIONS
for CHDSPH patients, the indication of the surgical closure should be defined as PVR < 120 kPa x L(-1) x S(-1) and/or its Qp/Qs > or = 1.25.
Gan
Hui-li
HL
Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing 100029, China. ganhuili@hotmail.com
Zhang
Jian-qun
JQ
Bo
Ping
P
Zhou
Qi-wen
QW
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005163:Factor Analysis, Statistical; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D007223:Infant; D008297:Male; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult