Early results of the extracardiac conduit Fontan operation
Early results of the extracardiac conduit Fontan operation
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DOI：
10.1016/s0022-5223(99)70288-6
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发表时间：
1999-04-01
影响因子：
6
通讯作者：
Hanley, FL
中科院分区：
文献类型：
--
作者：
Petrossian, E;Reddy, VM;Hanley, FL
工作背景：在Fontan手术的改良中，心外入路可能为优化术后早期心室和肺血管功能提供最大的潜力，因为在大多数情况下，它可以在短时间的常温部分心肺转流中进行，而无需心脏停搏。在这项研究中，我们回顾了心外管道Fontan手术的经验，重点是术后早期结果。方法和结果：1992年7月至1997年4月，51例患者（中位年龄4.9岁）接受了心外管道Fontan手术。中位心肺转流时间为92分钟，并且在我们的经验过程中显着减少。仅5例患者（10%）进行了心内手术，仅11例患者（22%）进行了主动脉阻断。24例患者（47%）进行了术中开窗术。没有早期死亡。Fontan失败发生在1例患者中，该患者不适合Fontan手术。5例（10%）患者发生一过性室上性心律失常。胸管引流的中位时间为8天。与延长资源使用（机械通气、正性肌力支持、重症监护室停留时间和住院时间）显著相关的因素包括较长的搭桥时间和较高的Fontan压力。中位随访时间为1.9年，有1例患者在再次手术时因出血死亡。结论：心外管道Fontan手术的死亡率和发病率最低，改善的结果可能与心外入路的优势以及心室和肺血管功能的改善有关。
Background: Among the modifications of the Fontan operation, the extracardiac approach may offer the greatest potential for optimizing early postoperative ventricular and pulmonary vascular function, insofar as it can be performed with short periods of normothermic partial cardiopulmonary bypass and without cardioplegic arrest in most cases. In this study, we reviewed our experience with the extracardiac conduit Fontan operation, with a focus on early postoperative outcomes. Methods and results: Between July 1992 and April 1997, 51 patients (median age 4.9 years) underwent an extracardiac conduit Fontan operation. Median cardiopulmonary bypass time was 92 minutes and has decreased significantly over the course of our experience. Intracardiac procedures were performed in only 5 patients (10%), and the aorta was crossclamped in only 11 (22%). Intraoperative fenestration was performed in 24 patients (47%). There were no early deaths. Fontan failure occurred in 1 patient who was a poor candidate for the Fontan procedure. Transient supraventricular tachyarrhythmias occurred in 5 patients (10%). Median duration of chest tube drainage was 8 days. Factors significantly associated with prolonged resource use (mechanical ventilation, inotropic support, intensive care unit stay, and hospital stay) included longer bypass time and higher Fontan pressure. At a median follow-up of 1.9 years, there was 1 death from bleeding at reoperation. Conclusions: The extracardiac conduit Fontan procedure can be performed with minimal mortality and morbidity, Improved results may be related to advantages of the extracardiac approach and improved preservation of ventricular and pulmonary vascular function.