The Fontan procedure for tricuspid atresia: Early and late results of a 25-year experience with 216 patients
The Fontan procedure for tricuspid atresia: Early and late results of a 25-year experience with 216 patients
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DOI：
10.1016/s0735-1097(00)01164-5
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发表时间：
2001-03-01
影响因子：
24
通讯作者：
Danielson, GK
中科院分区：
文献类型：
--
作者：
Mair, DD;Puga, FJ;Danielson, GK
我们评估了1973年至1998年25年间在马约诊所接受非开窗Fontan手术的216例三尖瓣闭锁患者的手术和晚期死亡率以及目前的临床状况。背景Fontan手术消除了全身性低氧血症和心室容量超负荷，这是以前姑息治疗的特征。然而，它最初这样做的代价是体静脉和右心房高血压，这个“价格”的长期影响是未知的，当程序最初proposed.METHODS我们回顾了216例患者的临床记录。这些被任意分为早期（1973年至1980年），中期（1981年至1987年）和晚期（1988年至1997年）外科时代。还根据手术时的年龄分析了患者结局。手术和晚期死亡率和目前的临床状态确定在167 171存活的patients.Results总生存率为79%。最近十年，手术死亡率稳步下降，58例患者的死亡率为2%。晚期生存率也在不断提高。手术年龄对手术死亡率没有影响，晚期死亡率仅在18岁或以上手术的患者中显著增加。89%的存活患者目前处于纽约心脏协会I级或II级。结论：非开窗Fontan手术治疗三尖瓣闭锁的最初25年的经验令人满意，大多数存活者现在都能过上高质量的生活。这些结果证明了该手术在患有三尖瓣闭锁的儿童中的持续应用。CT Am Coil Cardiol 2001;37：933-9）（C）2001年美国心脏病学会。
OBJECTIVES We assessed the operative and late mortality and the present clinical status of 216 patients with tricuspid atresia who had a nonfenestrated Fontan procedure performed at the Mayo Clinic in the 25-year period 1973 to 1998.BACKGROUND The Fontan operation eliminates the systemic hypoxemia and ventricular volume overload characteristic of prior forms of palliation. However, it originally did so at the cost of systemic venous and right atrial hypertension, and the long-term effects of this "price" were unknown when the procedure was initially proposed.METHODS We reviewed the clinical records of the 216 patients retrospectively. These were arbitrarily grouped into early (1973 through 1980), middle (1981 through 1987) and late (1988 through 1997) surgical eras. Patient outcome was also analyzed according to age at surgery. Operative and late mortality rates were determined and present clinical status was ascertained in 167 of 171 surviving patients.RESULTS Overall survival was 79%. Operative mortality steadily declined and was 2% tone of 58 patients) during the most recent decade. Late survival also continues to improve. Age at operation had no effect on operative mortality, and late mortality was significantly increased only in patients who were operated on at age 18 years or older. Eighty-nine percent of surviving patients are currently in New York Heart Association class I or II.CONCLUSIONS The initial 25-year experience with the nonfenestrated Fontan procedure for tricuspid atresia has been gratifying, with most survivors now leading lives of good quality into adulthood. These results justify continued application of this procedure for children born with tricuspid atresia. CT Am Coil Cardiol 2001;37:933-9) (C) 2001 by the American College of Cardiology.