EFFECT OF AGE AND SURGICAL TECHNIQUE ON SYMPTOMATIC ARRHYTHMIAS AFTER THE FONTAN PROCEDURE
EFFECT OF AGE AND SURGICAL TECHNIQUE ON SYMPTOMATIC ARRHYTHMIAS AFTER THE FONTAN PROCEDURE
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DOI：
10.1016/s0002-9149(99)80106-4
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发表时间：
1995-08-15
影响因子：
2.8
通讯作者：
FRIEDMAN, RA
中科院分区：
文献类型：
--
作者：
CECCHIN, F;JOHNSRUDE, CL;FRIEDMAN, RA
本研究的目的是确定新型Fontan改良（有或无开窗的外侧隧道）和患者手术年龄对症状性术后早期和中期心律失常的发生率和影响的影响。Fontan手术的改良用于减少术后并发症，Fontan手术目前正在年轻患者中进行，以减少与年龄相关的心室功能变化。回顾性分析了1987年至1993年在德克萨斯儿童医院接受Fontan手术的151例连续患者的病历，年龄从1岁到49岁不等。确定了早期和中期心律失常的风险因素。手术时的年龄是早期房性心律失常（p = 0.03）、室性心律失常（p = 0.003）和交界性异位心动过速（JET）（p = 0.05）的独立预测因素。我们发现，手术时患者年龄越大，房性和室性心律失常的发生率越高，而患者年龄越小，JET的发生率越高。采用考克斯的比例风险模型，中间房性心律失常的风险后，横向隧道修改后的1/3，心房连接。接受Fontan手术的年轻患者发生早期房性和室性心律失常的风险较低，但发生JET的风险增加。可以进行外侧隧道改良以降低中间房性心律失常的风险。
The purpose of this study was to determine the effects of newer Fontan modifications (lateral tunnel with or without fenestration) and patient's age at surgery on the incidence and impact of symptomatic postoperative early and intermediate arrhythmias. Modifications to the Fontan procedure are used to decrease postoperative complications, and the Fontan procedure is now being performed on younger patients to reduce age-related changes in ventricular function. A retrospective review was done of the medical records of 151 consecutive patients, ranging in age from 1 to 49 years, who underwent a Fontan procedure at Texas Children's Hospital between 1987 and 1993. Risk factors were identified for early and intermediate arrhythmias. Age at time of the procedure was an independent predictor of early atrial arrhythmias (p = 0.03), ventricular arrhythmias (p = 0.003), and junctional ectopic tachycardia (JET) (p = 0.05). We found that the older the patient at surgery, the higher the incidence of atrial and ventricular arrhythmias, whereas the younger the patient, the higher the incidence of JET. Using Cox's proportional-hazards model, the risk of intermediate atrial arrhythmias after lateral tunnel modification was 1/3 that after atriopulmonary connection. Younger patients who underwent the Fontan procedure had a lower risk for early atrial and ventricular arrhythmia but an increased risk for JET, The lateral tunnel modification can be performed in order to reduce the risk of intermediate atrial arrhythmias.