Malhotra Sunil P, Ivy D Dunbar, Mitchell Max B, Campbell David N, Dines Marshall L, Miyamoto Shelley, Kay Joseph, Clarke David R, Lacour-Gayet Francois
Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA.
Circulation. 2008 Sep 30;118(14 Suppl):S177-81. doi: 10.1161/CIRCULATIONAHA.107.751784.
Outcomes of patients undergoing cavopulmonary palliation for single ventricle physiology may be impacted by living at altitude, as the passive pulmonary circulation is dependent on the resistance of the pulmonary vascular bed. The objective of this study is to identify risk factors for failure of cavopulmonary palliation at elevated altitude.
Between January 1995 and March 2007, 122 consecutive patients living at a mean altitude of 1600 m (range 305 to 2570) underwent a bidirectional Glenn (BDG). There was one in-hospital mortality and 7 late deaths. 52 have proceeded to the Fontan procedure. Survival after BDG was 92.4% at 5 years. Freedom from palliation failure, defined as death, transplant, BDG/Fontan takedown, or revision was 81% at 5 years. At a mean follow-up of 39.8 months, 90 patients (75%) were in New York Heart Association class I. Patients with failing cavopulmonary circulation had higher pre-BDG pulmonary artery pressure (PAP) (18.3+/-6.1 mm Hg versus 14.8+/-5.1 mm Hg, P=0.016) and higher pre-BDG transpulmonary gradient (TPG) (11.2+/-6.2 mm Hg versus 7.7+/-4.3 mm Hg, P=0.014). Post-BDG, patients with palliation failure had increased PAP (15.0+/-5.7 mm Hg versus 10.8+/-2.8 mm Hg, P=0.008) and indexed pulmonary vascular resistance (PVRI) (2.43+/-1.0 Wood U . m(2) versus 1.52+/-0.9 Wood U . m(2), P=0.007).
The majority of patients at moderate altitude have favorable outcomes after BDG or Fontan palliation. Risk factors for palliation failure at elevated altitude include PAP >15 mm Hg, TPG >8 mm Hg, and PVRI >2.5 Wood U . m(2).
由于被动肺循环依赖于肺血管床的阻力，单心室生理状态下接受腔肺分流姑息手术的患者预后可能会受到居住在高原地区的影响。本研究的目的是确定高原地区腔肺分流姑息手术失败的危险因素。
1995年1月至2007年3月期间，122例平均居住在海拔1600米（范围305至2570米）的连续患者接受了双向格林分流术（BDG）。有1例住院死亡和7例晚期死亡。52例患者已接受了Fontan手术。BDG术后5年生存率为92.4%。无姑息手术失败（定义为死亡、移植、BDG/Fontan手术拆除或翻修）的比例在5年时为81%。平均随访39.8个月时，90例患者（75%）纽约心脏协会心功能分级为I级。腔肺循环功能衰竭的患者术前肺动脉压（PAP）较高（18.3±6.1毫米汞柱对14.8±5.1毫米汞柱，P=0.016），术前跨肺压差（TPG）较高（11.2±6.2毫米汞柱对7.7±4.3毫米汞柱，P=0.014）。BDG术后，姑息手术失败的患者PAP升高（15.0±5.7毫米汞柱对10.8±2.8毫米汞柱，P=0.008），肺血管阻力指数（PVRI）升高（2.43±1.0伍德单位·m²对1.52±0.9伍德单位·m²，P=0.007）。
大多数中度海拔地区的患者在接受BDG或Fontan姑息手术后预后良好。高原地区姑息手术失败的危险因素包括PAP>15毫米汞柱、TPG>8毫米汞柱和PVRI>2.5伍德单位·m²。
