Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus
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In brief
In brief
This study validates a protocol using quantified PDA flow patterns to optimize surgical timing for CDH repair. The protocol group achieved significantly shorter intubation duration compared to historical controls, suggesting that surgery guided by LR ratio >50% enables earlier, safer intervention without increasing pulmonary hypertension risk.
Written by the GCMD Library team from the article.
Abstract
Purpose
The optimal timing of surgery for congenital diaphragmatic hernia (CDH) is controversial. We aimed to validate our protocol for the timing of CDH repair using the quantified patent ductus arteriosus (PDA) flow pattern.
Methods
This retrospective comparative study analyzed patients with a prenatal diagnosis of isolated CDH between 2007 and 2020. We defined the “LR ratio” as the percentage of velocity–time integral (VTI) of the left-to-right flow of PDA against overall VTI on echocardiography. Since 2010, we followed the decision criterion of performing surgery when LR ratio of > 50% has been achieved in the patients (protocol group). The protocol group (2010–2020) was compared with the historical control group (2007–2009).
Results
The average age at surgery was 104.1 ± 175.9 and 37.3 ± 30.6 h in the control and protocol groups, respectively (p = 0.11). Survival rate (88.9% vs. 95.0%, p = 0.53) and the rate of worsening of pulmonary hypertension within 24 h after surgery (22.2% vs. 10.0%, p = 0.57) were not different between the groups. The protocol group had a significantly shorter duration of tracheal intubation (26.9 ± 21.1 vs. 13.3 ± 9.5 days, p = 0.03).
Conclusion
Our decision criterion might have the advantage of facilitating early and safe surgery for patients with CDH.