Extracardiac Fontan operation for complex cardiac anomalies: Seven years' experience
Extracardiac Fontan operation for complex cardiac anomalies: Seven years' experience
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DOI：
10.1016/s0022-5223(97)70016-3
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发表时间：
1997-12-01
影响因子：
6
通讯作者：
Marcelletti, C
中科院分区：
文献类型：
--
作者：
Amodeo, A;Galletti, L;Marcelletti, C
研究方法：在1988年至1995年期间，60例复杂心脏畸形患者接受了全心外腔静脉连接术，这是一种双向腔静脉吻合术与下腔静脉和肺动脉之间的心外导管间置术相结合的方法，只有1例患者可以直接吻合。在30例患者中，在初步双向腔静脉吻合后进行了全心外腔静脉连接，16例患者进行了改良的Damus-Kaye-Stansel吻合。导管由涤纶织物（n = 34），同种移植物（n = 3）和聚四氟乙烯（n = 22）构建。结果：总早期失败率为15%（n = 9）。死亡6例，3例因肺动脉狭窄和发育不全（n = 2）和严重房室瓣反流（n = 1）而拆除管道。另外2例患者因狭窄需要吻合口翻修。平均随访48个月（6至SG月），无晚期死亡（精算5年生存率88% +/- 4%）; 54例患者中有52例为纽约心脏协会I级或II级。2例患者在完全心外腔静脉连接后需要肺动脉球囊扩张或支架植入术，或两者兼而有之。在54名患者中的4名中检测到晚期快速性心律失常：2名患有病态窦房结综合征，需要植入起搏器，2名患有复发性Butter（精算5年无心律失常率为92% +/- 4%）。通过系列磁共振成像研究评价导管通畅性。初步数据显示，在全心外腔静脉连接后的前6个月内，导管内径平均减少17.8% +/- 7.6%，在接下来的5年内没有进展。结论：这些结果表明，全心外腔静脉连接提供了良好的早期和中期结果，并可能减少接受Fontan手术的患者中晚期心律失常的发生率。
Methods: Between 1988 and 1995, 60 patients with complex cardiac anomalies underwent a total extracardiac cavopulmonary connection, a combination of a bidirectional cavopulmonary anastomosis with an extracardiac conduit interposition between the inferior vena cava and pulmonary arteries, except in one patient in whom direct anastomosis was possible. In 30 patients the total extracardiac cavopulmonary connection followed preliminary bidirectional cavopulmonary anastomosis, associated with a modified Damus-Kaye-Stansel anastomosis in 16. The conduits were constructed of Dacron fabric (n = 34), homografts (n = 3), and polytetrafluoroethylene (n = 22). Results: Total early failure rate was 15% (n = 9). Six patients died, and three more had conduit take down owing to pulmonary artery stenosis and hypoplasia (n = 2) and severe atrioventricular valve regurgitation (n = 1). Two other patients required anastomosis revision owing to stricture. In a mean follow-up of 48 months (6 to SG monthe) there were no late deaths (actuarial 5-year survival 88% +/- 4%); 52 of 54 patients are in New York Heart Association class I or II. Two patients required pulmonary artery balloon dilation or stent implantation, or both, after total extracardiac cavopulmonary connection. Late tachyarrhythmias were detected in four of 54 patients: two had sick sinus syndrome with Butter necessitating a pacemaker implantation and two had recurrent Butter (actuarial 5-year arrhythmia-free rate 92% +/- 4%). Conduit patency was evaluated by serial magnetic resonance imaging studies. Preliminary data showed a 17.8% +/- 7.6% mean reduction in conduit internal diameter during the first 6 months after total extracardiac cavopulmonary connection, with no progression over the next 5 years. Conclusion: These results demonstrate that the total extracardiac cavopulmonary connection provides good early and midterm results and may reduce the prevalence of late arrhythmias in patients undergoing the Fontan operation.