Improved early results with the Fontan operation in adults with functional single ventricle
Improved early results with the Fontan operation in adults with functional single ventricle
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DOI：
10.1016/j.athoracsur.2003.10.011
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发表时间：
2004-04-01
影响因子：
4.6
通讯作者：
Fraser, CD
中科院分区：
文献类型：
--
作者：
Mott, AR;Feltes, TF;Fraser, CD
背景。越来越多的具有功能的单心室的成年人被认为是首次和二次丰坦手术的候选人。本研究描述了行丰坦改良术的成人的临床表现和早期手术结果。1995年7月至2003年4月，共有23例患者（18岁至18岁）接受了Fontan手术。我们回顾性地回顾了他们的围手术期病程。23例Fontan手术（首次手术[n 8]和再次手术[n = 15]）无早期或晚期死亡。没有患者需要再次手术。1例患者已被列入原位心脏移植名单。总体平均年龄为23岁（18至41岁）；平均随访30个月；术后平均住院时间8天（4 ~ 34天）；中位胸管引流时间4天（2 ~ 12天）。术后纽约心脏协会（NYHA）功能分级在23例患者中有22例得到改善。8例首次行Fontan手术（8例中有7例未开窗）；外侧隧道（n = 7）和心外导管（n = 1）。2例患者术前出现心律失常。2例患者出现需要治疗的新发心律失常（室性心动过速和窦房结功能障碍）。进行了15次redo-Fontan手术（均未开窗）；外侧隧道（n = 5）和心外导管（n = 10）。15例患者术前有心律失常，其中13例有房内再入性心动过速（GART），需要抗心律失常药物。同时进行术中射频消融（RFA） （n = 11）和冷冻消融（n = 1）。术后即刻有5例患者出现IART复发（rfa后[n = 4]和冷冻消融后[n = 1]）。在最近的随访中，没有患者正在接受抗心律失常药物治疗。2例患者新发房性心律失常需要治疗。Fontan手术可以在成人中进行，发病率低，NYHA功能分级改善。需要治疗的新发心律失常是围手术期发病率的来源。在redo-Fontan患者中，术前心律失常的完全解决可能无法在术后立即实现。然而，在早期随访中，对redoFontan患者的房性心动过速回路进行修改（术中射频消融-右心房消融术）可导致术前房性心动过速完全消失。
Background. A growing number of adults with functional single ventricles are presenting as candidates for first-time and redo-Fontan operations. This study describes the clinical presentation and early operative results of adults who have undergone Fontan modifications.Methods. Between July 1995 and April 2003,23 patients (>18 years old) had Fontan operations. We retrospectively reviewed their perioperative courses.Results. Twenty-three Fontan operations (first-time [n 8] and redo [n = 15]) were performed with no early or late deaths. No patient has required reoperation. One patient has been listed for orthotopic heart transplantation. The overall mean age is 23 years (18 to 41 years); mean follow-up, 30 months; median postoperative hospital stay, 8 days (4 to 34 days); and median duration of chest tube drainage, 4 days (2 to 12 days). The postoperative New York Heart Association (NYHA) functional class was improved in 22 of 23 patients. Eight first-time Fontan operations (7 of 8 nonfenestrated) were performed; lateral tunnel (n = 7) and extracardiac conduit (n = 1). Two patients had preoperative arrhythmias. New onset arrhythmias (ventricular tachycardia and sinus node dysfunction), requiring treatment, occurred in two patients. Fifteen redo-Fontan operations (all nonfenestrated) were performed; lateral tunnel (n = 5) and extracardiac conduit (n = 10). Fifteen patients had preoperative arrhythmias, thirteen of which had intraatrial reentry tachycardia GART) and required antiarrhythmic medications. Concomitant intraoperative radiofrequency ablation (RFA) (n = 11) and cryoablation (n = 1) procedures were performed. In the immediate postoperative period, there was IART recurrence in five patients (post-RFA [n = 4] and postcryoablation [n = 1]). At latest follow-up, no patient is being treated with antiarrhythmic medications. Two patients had new onset atrial arrhythmias that required treatment.Conclusions. The Fontan operation can be performed in adults with minimal morbidity and improved NYHA functional class. New onset arrhythmias requiring treatment are sources of perioperative morbidity. Complete arrhythmia resolution of the preoperative arrhythmia may not be achieved in the immediate postoperative period in redo-Fontan patients. However, modification (intraoperative radiofrequency ablation-right atrial debulking) of the atrial tachycardia circuits in the redoFontan patients can result in complete resolution of preoperative atrial tachyarrhythmias at early follow-up.