Cavopulmonary assist: (em)powering the univentricular fontan circulation.
Cavopulmonary assist: (em)powering the univentricular fontan circulation.
复制标题
DOI：
10.1053/j.pcsu.2011.01.015
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Giridharan GA
中科院分区：
文献类型：
--
作者：
Rodefeld MD;Frankel SH;Giridharan GA
自Fontan/Kreutzer手术引入以来，分期手术重建方法的临床进步显著改善了功能性单心室患者的预后。然而，重大挑战依然存在。早期死亡风险似乎难以逾越。严重的发病率——被认为是姑息治疗的不可改变的后果——几乎没有得到解决。晚期功能状态越来越多地与先前分期手术的病理生理后果联系在一起。随着越来越多的单心室患者存活到成年，Fontan衰竭正成为一个难以解决的问题，目前尚无靶向治疗方法。解决这些持续存在的问题的增量解决方案没有产生可衡量的影响。因此，从根本上重新考虑整个方法是合理和必要的。在全腔室肺连接处为现有的血流提供适度的升压（2-6 mmHg）的能力可以有效地恢复更稳定的双心室状态。这不仅会影响晚期丰坦衰竭的治疗，而且有助于早期手术修复。提供这种压力提升的现实方法从未出现过。最近的进展开始揭示实现这一目标必须解决的独特挑战，并有望打开单心室姑息治疗的新治疗前景。
Since the Fontan/Kreutzer procedure was introduced, evolutionary clinical advances via a staged surgical reconstructive approach have markedly improved outcomes for patients with functional single ventricle. However, significant challenges remain. Early stage mortality risk seems impenetrable. Serious morbidities - construed as immutable consequences of palliation - have hardly been addressed. Late functional status is increasingly linked to pathophysiologic consequences of prior staged procedures. As more single ventricle patients survive into adulthood, Fontan failure is emerging as an intractable problem for which there is no targeted therapy. Incremental solutions to address these ongoing problems have not had a measurable impact. Therefore, a fundamental reconsideration of the overall approach is reasonable and warranted. The ability to provide a modest pressure boost (2-6 mmHg) to existing blood flow at the total cavopulmonary connection can effectively restore more stable biventricular status. This would impact not only treatment of late Fontan failure, but also facilitate early surgical repair. A realistic means to provide such a pressure boost has never been apparent. Recent advances are beginning to unravel the unique challenges which must be addressed to realize this goal, with promise to open single ventricle palliation to new therapeutic vistas.