非开窗式心外腔 Fontan 手术：145 例患者队列研究。

The nonfenestrated extracardiac Fontan procedure: a cohort of 145 patients.

机构信息

Cardiovascular Surgery Department, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA.

出版信息

Ann Thorac Surg. 2010 Jun;89(6):1815-20. doi: 10.1016/j.athoracsur.2010.02.055.

DOI:10.1016/j.athoracsur.2010.02.055

PMID:20494033

Abstract

BACKGROUND

There are limited data available on the outcomes of single-ventricle patients who have undergone a nonfenestrated extracardiac Fontan procedure. This study examined the clinical experience of a large cohort of patients from a single institution who received this procedure.

METHODS

A retrospective data set of 145 patients who underwent a nonfenestrated extracardiac Fontan procedure from July 1997 to September 2008 was reviewed.

RESULTS

The hospital survival was 94.5%. Takedown of the Fontan conduit was necessary in 4 patients (2.8%), and 3 of these 4 patients were also operative deaths. Although female sex (p = 0.048), cardiopulmonary bypass time (p = 0.002), and aortic cross-clamp time (p = 0.007) were found to be significant in the univariate analysis, only sex (p = 0.035; odds ratio, 3.869; 95% confidence limits, 1.097 to 13.644) and cardiopulmonary bypass time in minutes (p = 0.001; odds ratio, 1.023; 95% confidence limits, 1.009 to 1.037) were found to be significant in the multivariate analysis for hospital survival. The late survival was 95.6% (131 of 137 patients) with a mean follow-up of 3.3 years (range, 0.0 to 10.8 years). The freedom from Fontan failure was 92% at 1 year, 89% at 5 years, and 82% at 10 years. Stepwise logistic regression found cardiopulmonary bypass time (p = 0.003; odds ratio, 1.023; 95% confidence limits, 1.008 to 1.039) to be a significant risk factor for late survival.

CONCLUSIONS

The nonfenestrated extracardiac Fontan procedure can be successfully used in the palliation of single-ventricle patients.

摘要

背景

目前关于接受非开窗式体外腔房通道 Fontan 手术的单心室患者的结局数据有限。本研究分析了单中心的大量患者的临床经验，这些患者接受了该手术。

方法

回顾性分析了 1997 年 7 月至 2008 年 9 月期间接受非开窗式体外腔房通道 Fontan 手术的 145 例患者的数据。

结果

院内存活率为 94.5%。4 例（2.8%）患者需要拆除 Fontan 导管，其中 3 例为手术死亡。虽然女性（p=0.048）、体外循环时间（p=0.002）和主动脉阻断时间（p=0.007）在单因素分析中具有显著意义，但只有性别（p=0.035；比值比，3.869；95%置信区间，1.097 至 13.644）和体外循环时间（p=0.001；比值比，1.023；95%置信区间，1.009 至 1.037）在多因素分析中与院内存活率相关。晚期存活率为 95.6%（137 例患者中的 131 例），平均随访 3.3 年（范围，0.0 至 10.8 年）。1 年时 Fontan 失败的无事件生存率为 92%，5 年时为 89%，10 年时为 82%。逐步逻辑回归发现体外循环时间（p=0.003；比值比，1.023；95%置信区间，1.008 至 1.039）是晚期生存的显著危险因素。