Integrated model for the prenatal diagnosis and postnatal surgical treatment of total anomalous pulmonary venous connection: A multidisciplinary collaborative experience and preliminary results

Current treatment outcomes of congenital heart disease and future perspectives

China has the largest number of individuals with congenital heart disease (CHD) in the world and a heavy burden of CHD. Therefore, understanding current CHD treatment outcomes and patterns in China will contribute to global progress in CHD treatment and be a valuable experience. Generally, CHD treatment in China has satisfactory outcomes owing to the joint efforts by all relevant stakeholders across the country. However, efforts are needed to overcome the remaining challenges: management of mitral valve disease and paediatric end-stage heart failure needs to be improved; cohesive paediatric cardiology teams should be established and collaboration between hospitals enhanced; CHD-related medical resources need to be more accessible and equitable; and nationwide CHD databases should be enhanced. In the second paper of this Series, we aim to systematically summarise the current CHD treatment outcomes in China, discuss potential solutions, and provide future perspectives.

Efficacy Study of Multidisciplinary Team Participating in the Perioperative Administration for Elderly Patients With Intertrochanteric Fractures: A Prospective Randomized Controlled Trail

OBJECTIVE

To evaluate the efficacy of the multidisciplinary team (MDT) participating in the perioperative administration and 1-year follow-up for elderly patients with intertrochanteric fractures.

METHOD

Elderly patients who underwent surgical treatment of intertrochanteric fractures in our hospital, from January 2018 to December 2020, were taken as the research object. According to the inclusion and exclusion criteria, a total of 76 patients were prospectively included and equally allocated to form a MDT group and a conventional group in this trial by the random number table method. The MDT was composed of doctors from nine disciplines, who would work jointly to evaluate the perioperative risk and formulate the treatment plan and the rehabilitation program.

RESULTS

Compared with the conventional group, the time before weight-bearing (59.93 ± 5.93 days vs 67.93 ± 5.87 days), fracture healing time (68.98 ± 7.82 days vs 78.91 ± 7.09 days), and the length of hospital stay (10.43 ± 2.01 days vs 13.87 ± 2.13 days) in the MDT group were all shorter, P < 0.001, and the VAS declined from 3.18 ± 0.81 to 2.28 ± 0.87 at 3 days after the operation and from 0.26 ± 0.04 to 0.23 ± 0.03 at 3 months after the operation in the MDT group, P < 0.001. Compared with the only case in the MDT group which had postoperative complications, postoperative complications were more common in the conventional group, and the difference was statistically significant, P = 0.025. At 1 month and 1 year after the operation, the Harris hip score results of the MDT group were all higher in the seven aspects than those in the conventional group; the difference was statistically significant ( P < 0.001).

CONCLUSION

The MDT participated in the perioperative management and the guidance of postoperative rehabilitation of elderly patients with intertrochanteric fractures can markedly improve perioperative symptoms, promote postoperative recovery, and improve long-term hip joint function.

[Integrated management during the perinatal period for total anomalous pulmonary venous connection]

OBJECTIVES

To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography.

METHODS

Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology.

RESULTS

Among the 64 TAPVC fetuses, there were 29 cases of supracardiac type, 27 cases of intracardiac type, 2 cases of infracardiac type, and 6 cases of mixed type. Chromosomal analysis was performed in 42 cases, and no obvious abnormalities were found. Among the 64 TAPVC fetuses, 37 were induced labor, and 27 were followed up until term birth. Among the 27 TAPVC cases, 2 cases accepted palliative care, 2 cases were referred to another hospital for treatment and lost to follow-up, while the remaining 23 cases underwent primary repair surgery. One case died within 6 months after the operation due to low cardiac output syndrome, while the other 22 cases were followed up for (2.1±0.3) years with good outcomes (2 cases underwent a second surgery within 1 year after the first operation due to anastomotic stenosis or pulmonary vein stenosis).

CONCLUSIONS

TAPVC fetuses can achieve good outcomes with integrated management during the perinatal period.

Two approaches for newborns with critical congenital heart disease: a comparative study

BACKGROUND

Prenatal diagnosis and planned peripartum care is an unexplored concept in China. This study aimed to evaluate the effects of the "prenatal diagnosis and postnatal treatment integrated model" for newborns with critical congenital heart disease.

METHODS

The medical records of neonates (≤ 28 days) admitted to Fuwai Hospital were reviewed retrospectively from January 2019 to December 2020. The patients were divided into "prenatal diagnosis and postnatal treatment integrated group" (n = 47) and "non-integrated group" (n = 69).

RESULTS

The age of admission to the hospital and the age at surgery were earlier in the integrated group than in the non-integrated group (5.2 ± 7.2 days vs. 11.8 ± 8.0 days, P < 0.001; 11.9 ± 7.0 days vs. 16.5 ± 7.7 days, P = 0.001, respectively). The weight at surgery also was lower in the integrated group than in the non-integrated group (3.3 ± 0.4 kg vs. 3.6 ± 0.6 kg, P = 0.010). Longer postoperative recovery time was needed in the integrated group, with a median mechanical ventilation time of 97 h (interquartile range 51-259 h) vs. 69 h (29-168 h) (P = 0.030) and with intensive care unit time of 13.0 days (8.0-21.0 days) vs. 9.0 days (4.5-16.0 days) (P = 0.048). No significant difference was observed in the all-cause mortality (2.1 vs. 8.7%, P = 0.238), but it was significantly lower in the integrated group for transposition of the great arteries (0 vs. 18.8%, log rank P = 0.032).

CONCLUSIONS

The prenatal diagnosis and postnatal treatment integrated model could significantly shorten the diagnosis and hospitalization interval of newborns, and surgical intervention could be performed with a lower risk of death, especially for transposition of the great arteries.