3.1 Risk factors for mortality
Ten patients died in the hospital, and 2 patients died after discharge
from the hospital during follow-up (8 and 10 months after the operation,
respectively). The early mortality rate was 13.9% (10/72), and the
overall mortality rate was 16.7% (12/72) at the median follow-up time
of 48 months (9.25-73.75), with 10 patients lost to follow-up. Two
patients in our series died within 24 hours postoperatively due to
coronary malperfusion, 1 patient died iatrogenically due to the
inotropic transfusion line being accidentally disconnected during
patient transfer from the operating room to the ICU, and 1 patient died
from intractable heart failure due to the misdiagnosis of left
ventricular outflow tract obstruction caused by accessory mitral valve
tissue. Additionally, 1 patient died on postoperative day (POD) #5
because of uncontrollable arrhythmia (junctional ectopic tachycardia).
The cause of death in the remaining 5 patients was related to nosocomial
infection, with most of these patients requiring preoperative
ventilation. The details of early mortality are described in Table 3.
There were two cases of late mortality. In the first case, the patient
died suddenly at 8 months postoperatively, despite a recent
echocardiogram showing normal biventricular function before death. The
second case of late death occurred at 10 months after the operation; due
to severe sepsis from pneumonia but had normal cardiac function at the
latest follow-up. The estimated 1-year, 5-year, and 9-year freedom from
death for the 72 patients were 83.2% (SD=4.4), 83.2% (SD=4.4) and
83.2% (SD=4.4), (95% CI, 0.7237 to 0.9012), respectively (Figure 2).
Competing risk analysis revealed that: intraoperative ventricular septal
defect enlargement [hazard ratio (HR) 7.23, 95% confidence interval
(CI) 3.1294-16.7167; P < 0.001], secondary aortic
cross clamping (HR 28.38, 95% CI 4.8427-166.3484; P <
0.001), post-operative pneumonia (HR 5.64, 95% CI 1.2724-24.9917;P = 0.023), and post-operative sepsis (HR 5.28, 95% CI
1.3512-20.6553; P = 0.017) were factors associated to overall
mortality. By Cox multivariable analysis, the Ao arch hypoplasia (HR
2.96, 95% CI 0.9170-9.5288; P = 0.07) are approaching
significant factors associated to overall mortality.