30-year experience of Fontan surgery: single-centre's data
30-year experience of Fontan surgery: single-centre's data
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DOI：
10.1186/s13019-017-0634-0
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发表时间：
2017-08-09
影响因子：
1.6
通讯作者：
Tarutis, Virgilijus
中科院分区：
文献类型：
--
作者：
Bezuska, Laurynas;Lebetkevicius, Virgilijus;Tarutis, Virgilijus
背景：Fontan手术自1968年开始实施以来，已经进行了多次修改。由于现在许多患者都能存活到成年，因此人们的注意力集中在他们的临床状态和晚期发病率上。我们报告我们30年的Fontan手术经验。方法：从1985年1月至2015年1月，80例患者接受Fontan手术。21例患者接受了房肺Fontan（组I），4例患者接受了全腔静脉连接（TCPC）与心房内侧隧道（组II），6例患者接受了心外TCPC与同种主动脉移植物（组III），49例患者接受了心外TCPC与膨胀聚四氟乙烯管道。随访早期和晚期死亡率、长期生存率、术后发病率和再手术率。结果：平均随访时间为7.4 ± 6.6年。Kaplan-Meier估计的15年生存率在组I中为42%，在组II中为50%，在组III中为83%，在组IV中为94%。ICU中位住院时间为90 h（IQR，46-119），气管插管时间为8 h（IQR，6-16），胸腔引流时间为18 d（IQR，12-28）。早期并发症为出血（6例）、Fontan循环中断（3例）和左心转流治疗急性心力衰竭（1例）。迟发性疾病包括心律失常（6例）、蛋白丢失性肠病（2例）、血栓栓塞（2例）和气管狭窄（1例）。14例患者（18%）有重做Fontan procedures.Conclusion：我们的系列显示Fontan完成后的改善结果，具有良好的中期结果后，心外TCPC与聚四氟乙烯管道扩张。应遵循长期结果。
Background: The Fontan procedure has been modified several times since it was introduced into practice in 1968. As many patients now survive to adulthood, attention is directed towards their clinical status and late morbidity. We report our surgical experience of 30 years in Fontan procedures.Methods: From January 1985 to January 2015, 80 patients underwent Fontan surgery. Twenty-one patients received an atrio-pulmonary Fontan (Group I), four patients underwent total cavopulmonary connection (TCPC) with an intra-atrial lateral tunnel (Group II), six patients received extra-cardiac TCPC with an aortic homograft (group III) and 49 patients received extra-cardiac TCPC with an expanded polytetrafluoroethylene conduit. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations.Results: The mean follow-up time was 7.4 +/- 6.6 years. The Kaplan-Meier estimated 15-year survival rate was 42% in Group I, 50% in Group II, 83% in Group III and 94% in Group IV. The median length of stay in intensive care unit, intubation and chest drain stay time were 90 h (IQR, 46-119), 8 h (IQR, 6-16) and 18 days (IQR, 12-28) respectively. Early complications were bleeding (6), taken down of Fontan circulation (3) and acute heart failure managed by left heart bypass (1). Late-occurring morbidities included arrhythmias (6), protein-losing enteropathy (2), thromboembolism (2) and tracheal stenosis (1). Fourteen patients (18%) had redo Fontan procedures.Conclusion: Our series showed improving results after Fontan completion with excellent mid-term outcome after extra-cardiac TCPC with expanded polytetrafluoroethylene conduit. The long-term result should be followed.