Nakano Toshihide, Kado Hideaki, Tachibana Tsuyoshi, Hinokiyama Kazuhiro, Shiose Akira, Kajimoto Masaki, Ando Yusuke
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.
Ann Thorac Surg. 2007 Nov;84(5):1619-25; discussion 1625-6. doi: 10.1016/j.athoracsur.2007.05.074.
Extracardiac conduit total cavopulmonary connection has shown good early results; however, its long-term outcome has yet to be reported.
Of 282 patients who underwent extracardiac conduit total cavopulmonary connection since 1994, 126 patients who have been followed up for more than 5 years were included in this retrospective study. Actuarial survival rate, incidence of late complications, hemodynamic variables, and results of exercise tolerance test were reviewed.
Follow-up time was 96.4 +/- 23.0 months. There was 1 operative death and 6 late deaths. Actuarial survival rate was 95.2% and 93.6% at 5 and 10 years, respectively. Seven patients had late complications including new-onset supraventricular arrhythmia in 3, protein-losing enteropathy in 2, thromboembolism in 1, and bleeding complication in 1. Seven patients underwent reoperation not related to the conduit. Freedom from Fontan-related events was 88.8% at 5 years and 84.3% at 10 years. Late cardiac catheterization in 119 survivors showed central venous pressure of 9.9 +/- 2.9 mm Hg, cardiac index of 3.6 +/- 0.8 L x min(-1) x m(-2) and arterial oxygen saturation of 94.5 +/- 2.3%. No patient showed conduit stenosis. Plasma concentration of atrial and brain natriuretic peptide (pg/mL) were 28.9 +/- 20.0 and 25.8 +/- 44.5. Exercise test performed in 101 patients showed endurance time of 75.7 +/- 12.9% of normal value, peak heart rate of 92.3 +/- 14.4% of normal, and peak oxygen consumption of 90.0 +/- 20.0% of normal. The latest echocardiogram showed ejection fraction of 60.4 +/- 11.7%. Three patients had pacemaker rhythm, 1 had junctional rhythm, and 115 patients had sinus rhythm.
Midterm outcome of extracardiac conduit total cavopulmonary connection was satisfactory with low incidence of late mortality and morbidity, and excellent hemodynamic state.
心外管道全腔静脉肺动脉连接术已显示出良好的早期效果；然而，其长期结果尚未见报道。
在1994年以来接受心外管道全腔静脉肺动脉连接术的282例患者中，本回顾性研究纳入了126例随访时间超过5年的患者。回顾了精算生存率、晚期并发症发生率、血流动力学变量以及运动耐量测试结果。
随访时间为96.4±23.0个月。有1例手术死亡和6例晚期死亡。5年和10年的精算生存率分别为95.2%和93.6%。7例患者出现晚期并发症，包括3例新发室上性心律失常、2例蛋白丢失性肠病、1例血栓栓塞和1例出血并发症。7例患者接受了与管道无关的再次手术。无Fontan相关事件生存率在5年时为88.8%，10年时为84.3%。119例幸存者的晚期心导管检查显示中心静脉压为9.9±2.9 mmHg，心脏指数为3.6±0.8 L×min⁻¹×m⁻²，动脉血氧饱和度为94.5±2.3%。无患者出现管道狭窄。心房利钠肽和脑利钠肽的血浆浓度（pg/mL）分别为28.9±20.0和25.8±44.5。101例患者进行的运动测试显示耐力时间为正常值的75.7±12.9%，峰值心率为正常值的92.3±14.4%，峰值耗氧量为正常值的90.0±20.0%。最新的超声心动图显示射血分数为60.4±11.7%。3例患者为起搏器心律，1例为交界性心律，115例患者为窦性心律。
心外管道全腔静脉肺动脉连接术的中期结果令人满意，晚期死亡率和发病率低，血流动力学状态良好。
