Jaquiss Robert D B, Siehr Stephanie L, Ghanayem Nancy S, Hoffman George M, Fedderly Raymond T, Cava Joseph R, Mussatto Kathy A, Tweddell James S
Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Ann Thorac Surg. 2006 Oct;82(4):1260-5; discussion 1265-6. doi: 10.1016/j.athoracsur.2006.04.095.
Children with univentricular hearts and aortic arch obstruction are treated sequentially with Norwood procedure, superior cavopulmonary anastomosis (SCPA), and Fontan operation. Early SCPA results in lower initial O2 saturation and longer hospitalization, but not increased mortality. We sought to determine the impact of early SCPA on Fontan candidacy and outcomes.
Eighty-five consecutive patients undergoing Norwood operation between January 1998 and February 2003 were divided into group 1 (SCPA at less than 4 months, n = 33) and group 2 (SCPA at more than 4 months, n = 52). Of the original cohort, 69 have undergone Fontan operation, 7 await Fontan, 1 was transplanted, 3 are not Fontan candidates, and 5 died late after SCPA. Group 1 (n = 25) and group 2 (n = 44) patients who have completed Fontan operation were compared for preoperative and perioperative variables: age, size, O2 saturation, pulmonary artery pressure and size, prevalence of tricuspid regurgitation and ventricular dysfunction, extubation rate in operating room, duration of pleural drainage, hospital stay, and discharge O2 saturation. Late functional status and ventricular function were also compared. Survival was compared for original groups 1 and 2.
There were no differences for any preoperative or perioperative variable, or late functional assessment. Actuarial survival at 6 years was also not different (88% +/- 5% for group 1 and 94% +/- 4% for group 2, p = 0.72).
Although initially more cyanotic and hospitalized longer than older peers, younger SCPA patients achieve clinical equivalence by the time of Fontan operation and afterward. We conclude that both short- and long-term outcomes support performance of early SCPA.
单心室合并主动脉弓梗阻的患儿需依次接受诺伍德手术、上腔静脉-肺动脉吻合术（SCPA）和Fontan手术。早期进行SCPA会导致初始氧饱和度降低和住院时间延长，但不会增加死亡率。我们试图确定早期SCPA对Fontan手术适应证及手术结果的影响。
将1998年1月至2003年2月期间连续接受诺伍德手术的85例患者分为1组（4个月龄以下行SCPA，n = 33）和2组（4个月龄以上行SCPA，n = 52）。在最初的队列中，69例已接受Fontan手术，7例等待Fontan手术，1例接受了移植，3例不适合行Fontan手术，5例在SCPA术后晚期死亡。对已完成Fontan手术的1组（n = 25）和2组（n = 44）患者的术前和围手术期变量进行比较：年龄、体型、氧饱和度、肺动脉压力和大小、三尖瓣反流和心室功能障碍的发生率、手术室拔管率、胸腔引流持续时间、住院时间和出院时氧饱和度。还比较了晚期功能状态和心室功能。比较了原1组和2组的生存率。
术前或围手术期变量以及晚期功能评估均无差异。6年的精算生存率也无差异（1组为88%±5%，2组为94%±4%，p = 0.72）。
尽管早期进行SCPA的患者最初比年龄较大的同龄人更易出现发绀且住院时间更长，但在进行Fontan手术时及之后，年轻患者在临床方面已无差异。我们得出结论，早期SCPA的短期和长期结果均支持其应用。
