Berdat P A, Belli E, Lacour-Gayet F, Planché C, Serraf A
Clinic for Cardiovascular Surgery, University Hospital, Berne, Switzerland.
Thorac Cardiovasc Surg. 2004 Oct;52(5):280-6. doi: 10.1055/s-2004-821102.
Use of additional sources of pulmonary blood flow (APBF) with bidirectional cavopulmonary anastomosis (BDG) and total cavopulmonary connection (TCPC) remains controversial. We have therefore assessed the effects of APBF on BDG and TCPC outcome.
From 1996 to 2000, 106 patients underwent BDG, either isolated (group 1, n = 54), or with APBF via pulmonary artery (PA) (group 2, n = 30), or Blalock-Taussig shunt (BTS) (group 3, n = 22) with 28 patients completed by TCPC.
After BDG low output syndrome was more frequent in group 2 and less in 3 ( p = 0.01), whereas superior cava syndrome was again more common in group 2 and less in groups 1 and 3 ( p < 0.05) than expected. Mortality and complications were similar after TCPC in all groups. Oxygen saturation (SaO (2)) was lower without than with APBF ( p < 0.002) after BDG and in group 3 than in group 2 after TCPC ( p < 0.05). Repeated measures ANOVA showed no effect of APBF on SaO (2), PA pressures, fractional shortening, end-diastolic pressure and AV-valve function.
Early after BDG, APBF via PA presents different difficulties than APBF via BTS. However, BDG and TCPC outcomes are not affected by the presence or absence of APBF.
在双向腔肺吻合术（BDG）和全腔肺连接术（TCPC）中使用额外的肺血流来源（APBF）仍存在争议。因此，我们评估了APBF对BDG和TCPC结果的影响。
1996年至2000年，106例患者接受了BDG，其中单独进行BDG的患者为1组（n = 54），通过肺动脉（PA）进行APBF的患者为2组（n = 30），通过Blalock-Taussig分流术（BTS）进行APBF的患者为3组（n = 22），另有28例患者完成了TCPC。
BDG术后，2组低输出量综合征更为常见，3组较少见（p = 0.01），而上腔静脉综合征在2组中同样更为常见，在1组和3组中比预期少见（p < 0.05）。所有组TCPC后的死亡率和并发症相似。BDG术后，无APBF时的氧饱和度（SaO₂）低于有APBF时（p < 0.002），且TCPC后3组的氧饱和度低于2组（p < 0.05）。重复测量方差分析显示，APBF对SaO₂、肺动脉压力、缩短分数、舒张末期压力和房室瓣功能无影响。
BDG术后早期，经PA的APBF与经BTS的APBF存在不同困难。然而，BDG和TCPC的结果不受APBF存在与否的影响。
