Early results of the "clamp and sew" Fontan procedure without the use of circulatory support.
Early results of the "clamp and sew" Fontan procedure without the use of circulatory support.
复制标题
不使用循环支持的“夹紧和缝合”Fontan 手术的早期结果。
DOI：
10.1016/j.athoracsur.2010.12.030
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Azakie,Anthony
中科院分区：
文献类型：
--
作者：
Shinkawa,Takeshi;Anagnostopoulos,PetrosV;Johnson,NatalieC;Presnell,Laura;Watanabe,Naruhito;Sapru,Anil;Azakie,Anthony
背景最近对Fontan手术进行了修改，包括使用简单的夹闭将心外管道与右肺动脉和下腔静脉吻合，无需额外的循环支持、静脉分流、肺动脉准备或预先维持奇静脉通畅。本研究的目的是评估这种新的非体外循环“钳缝”Fontan程序的结果。MethodsThis是一个回顾性的回顾性研究，2009年1月和2010年10月之间的Fontan程序在一个单一的institution.ResultsTwelve患者有一个Fontan程序与使用体外循环（CPB组），和12个非体外循环Fontan程序（非体外循环组）。术前人口统计学和血流动力学数据相似，但CPB组的平均肺动脉压较高（12.2 ± 1.6 mm Hg vs 9.9 ± 2.4 mm Hg;p= 0.02）。非体外循环组无患者需要转CPB。非体外循环组患者的平均下腔静脉阻断时间为10 ± 3 min。没有早期或中期死亡。无患者出现术后肝或肾功能不全。非体外循环组的术后最大血清肌酐和天冬氨酸转氨酶显著低于CPB组（分别为0.59 ± 0.12 vs 0.77 ± 0.22 mg/dL;p= 0.03和35.5 ± 8.3 vs 53.1 ± 19.0 U/L;p= 0.02）。在平均随访13个月（范围，1至20个月），所有，但1例患者在CPB组中的纽约心脏协会I级畅通Fontan circulation.ConclusionsThe钳和缝技术完成的心外管道Fontan程序似乎是安全和可行的选定的患者。
BackgroundA modification of the Fontan operation was recently applied, which includes anastomoses of the extracardiac conduit to the right pulmonary artery and inferior vena cava using simple clamping with no additional circulatory support, venous shunting, pulmonary artery preparation, or prior maintenance of azygos vein patency. The objective of this study is to assess the outcomes of this novel off-pump “clamp and sew” Fontan procedure.MethodsThis is a retrospective review of all patients having a Fontan procedure between January 2009 and October 2010 at a single institution.ResultsTwelve patients had a Fontan procedure with the use of cardiopulmonary bypass (CPB group), and 12 had an off-pump Fontan procedure (off-pump group). Preoperative demographic and hemodynamic data were similar except for higher mean pulmonary artery pressure in the CPB group (12.2 ± 1.6 mm Hg versus 9.9 ± 2.4 mm Hg;p= 0.02). No patients in the off-pump group required conversion to CPB. The mean inferior vena cava clamp time in the off-pump group patients was 10 ± 3 minutes. There were no early or midterm deaths. No patients exhibited postoperative hepatic or renal dysfunction. Postoperative maximal serum creatinine and aspartate transaminase were significantly lower in the off-pump group compared with the CPB group (0.59 ± 0.12 versus 0.77 ± 0.22 mg/dL;p= 0.03 and 35.5 ± 8.3 versus 53.1 ± 19.0 U/L;p= 0.02, respectively). At median follow-up of 13 months (range, 1 to 20 months), all but 1 patient in the CPB group are in New York Heart Association class I with unobstructed Fontan circulation.ConclusionsThe clamp and sew technique for completion of an extracardiac conduit Fontan procedure appears safe and feasible for selected patients.