Bridges N D, Mayer J E, Lock J E, Jonas R A, Hanley F L, Keane J F, Perry S B, Castaneda A R
Department of Cardiology, Children's Hospital, Boston.
Circulation. 1992 Dec;86(6):1762-9. doi: 10.1161/01.cir.86.6.1762.
The "fenestrated Fontan" (surgical baffle fenestration followed by transcatheter test occlusion and permanent closure after postoperative recovery) was adopted in an effort to reduce perioperative mortality and morbidity. This study assesses the effect of baffle fenestration on outcome.
Patients having a modified Fontan operation with a cavocaval baffle and cavopulmonary anastomosis were retrospectively selected for study. Those with baffle fenestration (n = 91) were compared with those without baffle fenestration (n = 56) with respect to preoperative risk factors, age, anatomy, surgical date, and presence or absence of a previous bidirectional cavopulmonary anastomosis. Outcome variables were failure (death or take-down) and duration of postoperative pleural effusions and hospitalization. Survival and clinical status after hospital discharge were ascertained. The two groups did not appear to differ with respect to age or anatomic diagnosis. Patients having baffle fenestration were at significantly greater preoperative risk by univariate and multivariate analysis (p < 0.01). Operative failure was low in both groups (11% without and 7% with baffle fenestration, p = NS). Durations of pleural effusions and hospitalization were significantly shorter with baffle fenestration (p < 0.01). Neither date of surgery nor a previous bidirectional cavopulmonary anastomosis appeared to contribute to improved outcome. Patients with baffle fenestration had lower postoperative systemic venous pressure (p < 0.01). There were no late deaths. Functional status in both groups is good (82% in New York Heart Association class I).
Baffle fenestration is associated with low mortality, significantly less pleural effusion, and significantly shorter hospitalization among high-risk patients having a modified Fontan operation.
“开窗式Fontan手术”（手术挡板开窗，术后恢复后经导管进行试验性封堵和永久性封堵）旨在降低围手术期死亡率和发病率。本研究评估挡板开窗对手术结果的影响。
回顾性选取接受改良Fontan手术（腔静脉挡板和腔肺吻合术）的患者进行研究。将有挡板开窗的患者（n = 91）与无挡板开窗的患者（n = 56）在术前危险因素、年龄、解剖结构、手术日期以及是否曾进行双向腔肺吻合术方面进行比较。结果变量包括手术失败（死亡或手术取消）、术后胸腔积液持续时间和住院时间。确定出院后的生存率和临床状况。两组在年龄或解剖诊断方面似乎没有差异。单因素和多因素分析显示，有挡板开窗的患者术前风险显著更高（p < 0.01）。两组手术失败率均较低（无开窗组为11%，有开窗组为7%，p = 无显著差异）。有挡板开窗的患者胸腔积液持续时间和住院时间显著缩短（p < 0.01）。手术日期和既往双向腔肺吻合术似乎均未对改善手术结果有贡献。有挡板开窗的患者术后体循环静脉压较低（p < 0.01）。无晚期死亡病例。两组的功能状态良好（纽约心脏协会I级患者占82%）。
在接受改良Fontan手术的高危患者中，挡板开窗与低死亡率、显著减少的胸腔积液以及显著缩短的住院时间相关。
