Improved early morbidity and mortality after fontan operation: The Mayo Clinic experience, 1987 to 1992
Improved early morbidity and mortality after fontan operation: The Mayo Clinic experience, 1987 to 1992
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DOI：
10.1016/0735-1097(96)00135-0
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发表时间：
1996-08-01
影响因子：
24
通讯作者：
Danielson, GK
中科院分区：
文献类型：
--
作者：
Cetta, F;Feldt, RH;Danielson, GK
目标。这项研究试图评估我们最近接受改良Fontan手术的339名患者的早期发病率和死亡率的变化以及预后的预测因素。Fontan手术是功能性单心室患者首选的最终姑息治疗方法。先前报道的Fontan手术后的早期死亡率是实质性的。我们回顾了1987-1992年间在梅奥诊所连续接受Fontan手术的339名患者的记录(最近的队列)。这一队列与1973-1986年间接受Fontan手术的500名患者(早期队列)进行了比较。最近，与早期队列相比，方坦治疗后的总体早期死亡率显著下降(从16%降至9%，p=0.002)。尽管患者的解剖复杂性增加了，但这种下降还是发生了。近期患者的短期存活率也有显著改善，1年存活率从79%提高到88%，5年存活率从73%提高到81%(p=0.006)。有共同房室瓣膜的患者和那些术前每天服用利尿剂药物或术后有肾功能衰竭或搭桥后右心房压力升高的患者，早期死亡的风险增加。年轻并不是早期死亡的危险因素。异位症患者的早期死亡率显著降低：最近30天的死亡率为15%，而早期异位症患者为41%。方坦治疗后早期死亡率下降可能与多种因素有关。患者选择的改进、手术时年龄的年轻化、手术技术的改进和术后管理都可能起到重要作用。必须根据这些改进后的结果对丰坦行动拟议的技术改进进行评估。
Objectives. This study sought to evaluate changes in early morbidity and mortality as well as predictors of outcome in our most recent 339 patients undergoing modified Fontan operations.Background. The Fontan operation is the preferred definitive palliation for patients with functional single ventricles. Previously reported early mortality rates after Fontan operation have been substantial.Methods. Records of 339 consecutive patients who had a Fontan operation at the Mayo Clinic between 1987 and 1992 (recent cohort) were reviewed. This cohort was compared with the previous 500 patients who had Fontan operations performed between 1973 and 1986 (early cohort).Results. Recently, overall early mortality after Fontan has decreased significantly compared with that for the early cohort (from 16% to 9%, p = 0.002). This decline occurred despite increased anatomic complexity of patients. Short-term posthospital survival has also improved significantly in recent patients.One-year survival improved to 88% from 79%, and 5-year survival to 81% from 73% (p = 0.006). Patients with common atrioventricular valves and those who took daily preoperative diuretic medication or had either postoperative renal failure or elevated postbypass right atrial pressure were at increased risk for early mortality. Young age was not found to be a risk factor for early mortality. Early mortality for patients with heterotaxia decreased dramatically: recent 30 day mortality was 15% compared with 41% in the early heterotaxy cohort.Conclusions. Many factors may have contributed to decreased early mortality after Fontan. Improved patient selection, younger age at time of operation, refinements in surgical techniques and postoperative management may all have had important roles. Proposed technical modifications of the Fontan operation must be evaluated in light of these improved results.