Berdat Pascal A, Belli Emré, Lacour-Gayet François, Planché Claude, Serraf Alain
Clinic for Cardiovascular Surgery, University Hospital, Bern, Switzerland.
Ann Thorac Surg. 2005 Jan;79(1):29-36; discussion 36-7. doi: 10.1016/j.athoracsur.2004.06.002.
Controversy continues over whether additional sources of pulmonary blood flow are beneficial in combination with a bidirectional cavopulmonary anastomosis. We have therefore assessed the effects of additional pulmonary blood flow on outcome after bidirectional cavopulmonary anastomosis.
From 1996 to 2000, 106 patients underwent bidirectional cavopulmonary anastomosis, either isolated (group 1, n = 54), or with additional pulmonary blood flow through the pulmonary artery (group 2, n = 30) or a Blalock-Taussig shunt (group 3, n = 22).
Superior vena cava syndrome was more frequent in group 2 and less in groups 1 and 3 (p < 0.05). Low-output syndrome was more frequent in group 2 and less in group 3 (p = 0.01). Repeated-measures analysis of variance showed higher oxygen saturations with additional pulmonary blood flow (p < 0.05) and significant changes over time (p < 0.0001). Pulmonary pressures, systemic ventricular fractional shortening, end-diastolic diameter index, end-diastolic pressure, and atrioventricular valve regurgitation remained unaffected by additional pulmonary blood flow. Pulmonary artery pressures were lower in group 2 than 3 (p < 0.05). Fractional shortening (p < 0.05) and atrioventricular valve regurgitation (p < 0.0001) changed significantly over time. Fractional shortening showed a strong trend toward different changing patterns with or without additional pulmonary blood flow (p = 0.055), and atrioventricular valve regurgitation showed different changing patterns among the groups (p < 0.005). End-diastolic diameter and pulmonary artery dimensions, which were smaller than normal, remained unchanged. In logistic regression, smaller body surface area at bidirectional cavopulmonary anastomosis, single ventricle, and bidirectional cavopulmonary anastomosis with a Blalock-Taussig shunt were associated with early death. Actuarial survival including total cavopulmonary connection did not differ among groups (p = 0.96).
We conclude that additional pulmonary blood flow has no adverse effect on outcome after cavopulmonary anastomosis. Additional flow through the main pulmonary artery offers different advantages and disadvantages concerning perioperative complications and pulmonary artery growth compared with additional flow through a Blalock-Taussig shunt.
对于在双向腔肺吻合术基础上增加肺血流来源是否有益仍存在争议。因此，我们评估了增加肺血流对双向腔肺吻合术后结局的影响。
1996年至2000年，106例患者接受了双向腔肺吻合术，其中单纯手术（第1组，n = 54），或通过肺动脉增加肺血流（第2组，n = 30），或通过Blalock-Taussig分流术增加肺血流（第3组，n = 22）。
第2组上腔静脉综合征更为常见，第1组和第3组较少见（p < 0.05）。第2组低心排血量综合征更为常见，第3组较少见（p = 0.01）。重复测量方差分析显示，增加肺血流时氧饱和度更高（p < 0.05），且随时间有显著变化（p < 0.0001）。肺血流增加对肺压力、体循环心室短轴缩短率、舒张末期直径指数、舒张末期压力和房室瓣反流无影响。第2组肺动脉压力低于第3组（p < 0.05）。短轴缩短率（p < 0.05）和房室瓣反流（p < 0.0001）随时间有显著变化。短轴缩短率在有无增加肺血流时显示出不同变化模式的强烈趋势（p = 0.055），房室瓣反流在各组间显示出不同变化模式（p < 0.005）。小于正常的舒张末期直径和肺动脉尺寸保持不变。在逻辑回归分析中，双向腔肺吻合术时较小的体表面积、单心室以及伴有Blalock-Taussig分流术的双向腔肺吻合术与早期死亡相关。包括完全腔肺连接在内的精算生存率在各组间无差异（p = 0.96）。
我们得出结论，增加肺血流对腔肺吻合术后结局无不良影响。与通过Blalock-Taussig分流术增加肺血流相比，通过主肺动脉增加肺血流在围手术期并发症和肺动脉生长方面有不同的优缺点。
