5-YEAR TO 15-YEAR FOLLOW-UP AFTER FONTAN OPERATION
5-YEAR TO 15-YEAR FOLLOW-UP AFTER FONTAN OPERATION
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DOI：
10.1161/01.cir.85.2.469
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发表时间：
1992-02-01
期刊：
影响因子：
37.8
通讯作者：
DANIELSON, GK
中科院分区：
文献类型：
--
作者：
DRISCOLL, DJ;OFFORD, KP;DANIELSON, GK
背景本研究的目的是估计生存率和质量的结果和评估因素与结果的病人了5至15年，从他们的Fontan option.Methods和结果。我们研究了352例在1985年之前接受Fontan手术的患者。总的1年、5年和10年生存率分别为77%、70%和60%。以下因素与较低的生存率显著相关：单心室心脏或复杂先天性畸形（三尖瓣闭锁除外）、手术日历年早、异位综合征、手术年龄早、肺动脉压升高、房室瓣功能障碍和较高（较差）的纽约心脏协会分级。352例患者中有103例需要再次手术。至少20%的幸存者患有或曾经患有心律失常，需要抗心律失常药物或机械起搏器植入。7%-10%的患者患有或曾经患有蛋白丢失性肠病/低蛋白血症。术后5年，122例患者（34.7%）存活，纽约心脏协会功能分级优于术前。58例患者（16.5%）存活，功能分级相同，但126例（35.8%）在前5年内死亡或功能分级较差。术后5年，优39例，差29例。在存活的患者中，43%的患者可以像同龄人一样进行尽可能多的运动，而3%的患者不能进行运动。为了确保良好的功能长期结果，除了生存，临床医生必须排除选择Fontan手术的患者，已知的死亡或预后不良的高风险。
Background. The purpose of this study was to estimate survival and quality of outcome and assess factors associated with outcome for patients out 5 to 15 years from their Fontan operation.Methods and Results. We studied 352 patients who had the Fontan operation prior to 1985. The overall 1-, 5-, and 10-year survival was 77%, 70%, and, 60%, respectively. The following factors were significantly associated with lower survival: univentricular heart or complex congenital anomalies other than tricuspid atresia, early calendar year of operation, heterotaxia syndromes, early age at operation, increased pulmonary artery pressure, atrioventricular valve dysfunction, and higher (worse) New York Heart Association class. Reoperations were necessary for 103 of the 352 patients. At least 20% of the survivors have or have had cardiac arrhythmias requiring antiarrhythmic medication or mechanical pacemaker insertion. Between 7% and 10% of the patients have had or had protein-losing enteropathy/hypoproteinemia. At 5 years postoperatively, 122 patients (34.7%) were alive with a better New York Heart Association functional classification than preoperatively. Fifty-eight patients (16.5%) were alive and in the same functional classification, but 126 (35.8%) died within the first 5 years or were in a worse functional classification. Thirty-nine patients were doing excellently and 29 patients poorly 5 years after the operation. Of the surviving patients, 43% can do as much exercise as their peers, whereas 3% are incapable of exercise.Conclusions. To assure good functional long-term outcome in addition to survival, clinicians must exclude from selection for Fontan operation patients known to be at high risk for death or poor outcome.