Weber H S, Gleason M M, Myers J L, Waldhausen J A, Cyran S E, Baylen B G
Section of Pediatrics (Cardiology), Pennsylvania State University, Milton S. Hershey Medical Center, Hershey 17033.
J Am Coll Cardiol. 1992 Mar 15;19(4):828-33. doi: 10.1016/0735-1097(92)90526-s.
Young age remains a reported risk factor for a successful Fontan operation despite improved survival rates. Since March 1978, the Fontan operation has been performed in 47 patients. To avoid a primary or secondary palliative shunt, an early Fontan procedure (Group 1: mean age 1.5 +/- 0.5 years, range 0.6 to 2) has been performed in 17 children with the outcome similar to that of the remaining 30 older patients (Group 2: mean age 7.5 +/- 5 years, range 2.4 to 23 years). Preoperatively both groups had acceptable hemodynamic status for a successful Fontan result. Operative variables including cardiopulmonary bypass time, aortic cross-clamp time and core temperature were similar between groups and did not affect mortality. The postoperative mortality rate including early surgical (0% vs. 13%, respectively), late (18% vs. 12%) and total (18% vs. 23%) was similar between Groups 1 and 2 (p greater than 0.05). Immediate postoperative arrhythmias were more frequent in Group 1 (71% vs. 25%, p less than 0.01) with no related mortality, while late arrhythmias occurred with equal frequency (29% vs. 39%, p greater than 0.05). Group 1 infants required a longer hospital stay (22 +/- 9 vs. 14 +/- 5 days, p less than 0.01). Thus, young age is not a risk factor for successful outcome of the Fontan operation in patients with acceptable preoperative hemodynamic status. An early Fontan operation may also avoid prolonged palliative procedures and their potential deleterious effects.
尽管生存率有所提高，但年轻仍是据报道的影响Fontan手术成功的一个风险因素。自1978年3月以来，已对47例患者实施了Fontan手术。为避免一期或二期姑息性分流，对17名儿童实施了早期Fontan手术（第1组：平均年龄1.5±0.5岁，范围0.6至2岁），其结果与其余30名年龄较大的患者（第2组：平均年龄7.5±5岁，范围2.4至23岁）相似。术前两组患者的血流动力学状态对于Fontan手术成功而言均可接受。包括体外循环时间、主动脉阻断时间和核心体温在内的手术变量在两组之间相似，且不影响死亡率。第1组和第2组术后死亡率包括早期手术死亡率（分别为0%对13%）、晚期死亡率（18%对12%）和总死亡率（18%对23%）相似（p>0.05）。第1组术后即刻心律失常更为常见（71%对25%，p<0.01），且无相关死亡，而晚期心律失常发生率相同（29%对39%，p>0.05）。第1组婴儿住院时间更长（22±9天对14±5天，p<0.01）。因此，对于术前血流动力学状态可接受的患者，年轻并非Fontan手术成功结局的风险因素。早期Fontan手术还可避免长期的姑息性手术及其潜在的有害影响。
