RISK-FACTORS FOR ATRIAL TACHYARRHYTHMIAS AFTER THE FONTAN OPERATION
RISK-FACTORS FOR ATRIAL TACHYARRHYTHMIAS AFTER THE FONTAN OPERATION
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DOI：
10.1016/0735-1097(94)90181-3
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发表时间：
1994-12-01
影响因子：
24
通讯作者：
FREEDOM, RM
中科院分区：
文献类型：
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作者：
GELATT, M;HAMILTON, RM;FREEDOM, RM
目标。本研究的目的是确定 Fontan 手术后房性快速心律失常的发生率和危险因素。背景。房性快速心律失常会导致 Fontan 手术后发病。致病因素可能受到全身与肺部连接类型的影响。方法。 1982 年至 1992 年间，连续对 270 名患者进行了 Fontan 手术。手术时的平均年龄为 7.0 +/- 4.3 岁。 138 名患者（51%）采用直接房肺连接，94 名患者（35%）采用全腔肺连接，38 名患者（14%）采用右心房至右心室连接。结果。 55 名患者 (20%) 术后早期出现房性快速心律失常，术前房性快速心律失常是唯一的危险因素。对 228 名早期幸存者 (97%) 进行了随访，平均间隔为 4.4 年。有20人晚期死亡。接受房肺连接的患者中有 29% 患有晚期房性快速性心律失常，接受全腔肺连接的患者有 14%，接受右心室连接的患者有 18% (p < 0.02)。通过单变量和多元 Logistic 回归分析确定的显着危险因素是房肺连接类型（总腔肺连接类型的比值比为 0.40）。房肺连接 [p < 0.05] 和右心室相对于房肺连接 [p = 0.08] 为 0.37），较长的随访间隔（每年连续一年的比值比为 1.32 [p < 0.002]）和手术期间的房性快速心律失常（比值比 6.31 [p < 0.0001]）。结论。术后早期房性快速性心律失常、随访时间和房肺连接是晚期房性快速性心律失常出现的重要独立危险因素。
Objectives. The purpose of this study was to define the incidence and risk factors for atrial tachyarrhythmias after the Fontan operation.Background. Atrial tachyarrhythmias cause morbidity after the Fontan operation. Causative factors may be affected by the type of systemic to pulmonary connection.Methods. The Fontan operation was performed in 270 consecutive patients between 1982 and 1992. The mean age at operation was 7.0 +/- 4.3 years. Direct atriopulmonary connection was used in 138 patients (51%), total cavopulmonary connection in 94 (35%) and right atrial to right ventricular connection in 38 (14%).Results. Atrial tachyarrhythmias were seen early postopera tively in 55 patients (20%), preoperative atrial tachyarrhythmia being the only risk factor. Follow-up was achieved for 228 early survivors (97%) at a mean interval of 4.4 years. There were 20 late deaths. Late atrial tachyarrhythmias were noted in 29% of patients who received an atriopulmonary connection, 14% of those who received a total cavopulmonary connection and 18% of those who received a right ventricular connection (p < 0.02).Significant risk factors as determined by univariate and multiple logistic regression analysis were atriopulmonary connection type (odds ratio 0.40 for total cavopulmonary relative to atriopulmonary connection [p < 0.05] and 0.37 for right ventricular relative to atriopulmonary connection [p = 0.08]), longer follow-up interval (odds ratio 1.32 for each consecutive year [p < 0.002]) and atrial tachyarrhythmia in the operative period (odds ratio 6.31 [p < 0.0001]).Conclusions. Early postoperative atrial tachyarrhythmias, length of follow-up and atriopulmonary connection are significant independent risk factors for the presence of late atrial tachyarrhythmias.