Hosseinpour Amir-Reza D, Sudarshan Catherine, Davies Paul, Nashef Samer A M, Barron David J, Brawn William J
Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
J Cardiothorac Surg. 2006 Oct 2;1:31. doi: 10.1186/1749-8090-1-31.
The success of a Fontan circulation depends on several factors including low pulmonary vascular resistance. Pulmonary vascular resistance rises in response to hypoxia. Hypoxia is associated with altitude. Therefore, we wondered whether altitude is a risk factor for early failure after the Fontan operation. The aim was to test this hypothesis.
Data were obtained from all published series of 'total cavopulmonary' Fontan operations since 1990. The early failure rate from each series and the altitude of the respective cities were recorded. Early failure was defined as death, takedown of Fontan, or transplantation during the same hospital admission. The association between altitude and failure rate was investigated by rank correlation and logistic regression.
24 series were identified from centres situated at altitudes ranging from sea level to 520 metres. The plot of failure rate versus altitude suggests that failure rate increases with altitude. Logistic regression did not fit the data adequately. This was possibly due to the influence of unmeasured and unknown factors affecting the results, as well as the fact that centres were not randomly chosen but were self-selected by virtue of publishing their results. However, Spearman's rank correlation was 0.74 (p = 0.001).
The early outcome of the Fontan circulation appears to be adversely affected by altitude.
Fontan循环的成功取决于多个因素，包括低肺血管阻力。肺血管阻力会因缺氧而升高。缺氧与海拔高度有关。因此，我们想知道海拔是否是Fontan手术后早期失败的一个危险因素。目的是检验这一假设。
数据来自1990年以来所有已发表的“全腔静脉-肺动脉连接”Fontan手术系列。记录每个系列的早期失败率以及各自所在城市的海拔高度。早期失败定义为在同一次住院期间死亡、Fontan手术拆除或移植。通过等级相关和逻辑回归研究海拔与失败率之间的关联。
从海拔高度从海平面到520米的中心确定了24个系列。失败率与海拔高度的关系图表明失败率随海拔升高而增加。逻辑回归对数据的拟合效果不佳。这可能是由于影响结果的未测量和未知因素的影响，以及这些中心不是随机选择的，而是通过公布结果自行选择的这一事实。然而，Spearman等级相关系数为0.74（p = 0.001）。
海拔似乎对Fontan循环的早期结果产生不利影响。
