Scheurer Mark A, Hill Elizabeth G, Vasuki Nagavardhan, Maurer Scott, Graham Eric M, Bandisode Varsha, Shirali Girish S, Atz Andrew M, Bradley Scott M
Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):82-9, 89.e1-2. doi: 10.1016/j.jtcvs.2007.02.017.
Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis.
Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or transplanted) were assessed with Wilcoxon rank sum test and chi2 or Fisher exact tests. Survival functions were constructed with Kaplan-Meier estimates, and event times compared between subgroups with log-rank tests. Cox proportional hazard modeling was used for multivariable modeling of risk of death or transplantation.
One hundred sixty-seven patients underwent bidirectional cavopulmonary anastomosis with hemi-Fontan (n = 62) or bidirectional Glenn (n = 105) operations. Three patients died before discharge, 11 died later, and 1 has undergone transplantation. Freedom from death or transplantation after bidirectional cavopulmonary anastomosis was 96% at 1 year and 89% at 5 years. Multivariable analysis of preoperative variables showed atrioventricular valve regurgitation to be an independent risk factor for death or transplantation (hazard ratio 2.8, 95% confidence interval 1.1-7.1, P = .02).
Although survival after bidirectional cavopulmonary anastomosis is high, preoperative atrioventricular valve regurgitation is an important risk factor for death or transplantation.
功能单心室双向腔肺吻合术后生存的预后因素尚未明确界定。我们分析了术前血流动力学和超声心动图数据，以确定双向腔肺吻合术后至少1年死亡或移植的危险因素。
分析了1995年9月至2005年6月在我院5岁前接受双向腔肺吻合术的所有患者的数据。回顾了可用的术前超声心动图和心导管检查结果。将幸存者与死亡或接受移植的患者进行比较。采用Wilcoxon秩和检验、卡方检验或Fisher精确检验评估人口统计学和临床危险因素与生存状态（未移植存活与死亡或移植）之间的双变量关联。用Kaplan-Meier估计构建生存函数，并用对数秩检验比较亚组之间的事件发生时间。采用Cox比例风险模型对死亡或移植风险进行多变量建模。
167例患者接受了半Fontan（n = 62）或双向Glenn（n = 105）手术的双向腔肺吻合术。3例患者在出院前死亡，11例随后死亡，1例接受了移植。双向腔肺吻合术后1年无死亡或移植的生存率为96%，5年为89%。术前变量的多变量分析显示房室瓣反流是死亡或移植的独立危险因素（风险比2.8，95%置信区间1.1 - 7.1，P = 0.02）。
尽管双向腔肺吻合术后生存率较高，但术前房室瓣反流是死亡或移植的重要危险因素。
