Mendoza Alberto, Albert Leticia, Ruiz Enrique, Boni Lorenzo, Ramos Victoria, Velasco Jose M, Herrera Dolores, Granados Miguel A, Comas Juan V, Perez Ana
Instituto Pediátrico del Corazón, Hospital 12 de Octubre, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2012 Apr;65(4):356-62. doi: 10.1016/j.recesp.2011.11.018. Epub 2012 Feb 10.
The Fontan operation is usually the final palliative procedure in patients with univentricular heart. The objectives of this study were, firstly, to describe the clinical and haemodynamic characteristics of a group of patients with univentricular physiology who had previously been palliated with a bidirectional Glenn procedure and, secondly, to identify risk factors that can influence postoperative outcomes after the Fontan operation.
Retrospective study with 32 patients who underwent a Fontan operation between March 2000 and December 2009. Clinical characteristics, catheterization data, type and duration of surgery were revised and analyzed as predictors of postoperative outcome.
Hospital mortality was 3%. After a median follow-up of 44 months (interquartile range, 32-79), survival was 90%. Preoperative mean pulmonary artery pressure (measured during catheterization) was correlated with late mortality. Of the remaining variables analyzed, the Nakata and McGoon indices, and duration of cardiopulmonary bypass showed the highest correlations with postoperative outcomes. Interventional catheterization before the Fontan operation was performed in 42% of patients.
Hospital mortality after the Fontan operation was very low. The performance of a haemodynamic study before the Fontan operation made it possible to select high-risk patients for surgery as well as permitting the performance of interventional procedures that could improve postoperative outcome in these patients.
Fontan手术通常是单心室心脏患者的最终姑息性手术。本研究的目的，首先是描述一组曾接受双向格林分流术姑息治疗的单心室生理患者的临床和血流动力学特征，其次是确定可影响Fontan手术后预后的危险因素。
对2000年3月至2009年12月期间接受Fontan手术的32例患者进行回顾性研究。对临床特征、导管检查数据、手术类型和持续时间进行回顾并分析，作为术后预后的预测因素。
医院死亡率为3%。中位随访44个月（四分位间距，32 - 79个月）后，生存率为90%。术前平均肺动脉压（导管检查时测量）与晚期死亡率相关。在分析的其余变量中，Nakata指数和McGoon指数以及体外循环持续时间与术后预后的相关性最高。42%的患者在Fontan手术前进行了介入性导管检查。
Fontan手术后的医院死亡率非常低。Fontan手术前进行血流动力学研究能够筛选出手术高危患者，并允许进行可改善这些患者术后预后的介入性操作。
