Cardiac Surgery and Cardiology Departments, Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.
Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia.
J Thorac Cardiovasc Surg. 2014 Aug;148(2):566-75. doi: 10.1016/j.jtcvs.2013.09.074. Epub 2013 Nov 23.
This study examined changes in practice and analyzed risk factors for adverse early outcomes after Fontan surgery through use of a binational, population-based registry.
Demographic, preoperative, and perioperative data were collected from all participating institutions of the Australia and New Zealand Fontan Registry. Patient and operative characteristics were analyzed with multivariable logistic regression for impact on early mortality, early Fontan failure (death, takedown, or mechanical support), effusions (prolonging hospital stay >30 days or requiring surgical reintervention), and stay longer than 30 days.
Overall mortality was 3.5% (37/1071) and declined throughout the study period, from 8% (1975-1990) to 4% (1991-2000) and 1% (2001-2010). There were no differences between the extracardiac and lateral tunnel modifications for any outcome. After 2006, the extracardiac conduit was performed exclusively, with 1.3% mortality. The proportion of patients with hypoplastic left heart syndrome rose to 17% in the current era, and this group had more effusions (odds ratio, 3.0; 95% confidence interval, 1.4-6.6) and stayed on average 2 days longer in the hospital. Hypoplastic left heart syndrome was also an independent risk factor for composite adverse early outcome (death, failure, prolonged effusions, or prolonged stay >30 days; odds ratio, 2.6; 95% confidence interval 1.4-4.8 respectively).
The extracardiac conduit is now the exclusive Fontan modification performed in Australia and New Zealand. Even with a higher proportion of high-risk cases, perioperative outcomes are excellent in the modern era. Hypoplastic left heart syndrome confers a higher risk of prolonged pleural effusion and early composite adverse outcome.
本研究通过使用一个中澳两国人群为基础的注册系统，分析 Fontan 手术后实践变化情况，并分析不良早期结局的危险因素。
从参与澳大利亚和新西兰 Fontan 注册系统的所有机构收集人口统计学、术前和围手术期数据。使用多变量逻辑回归分析患者和手术特征对早期死亡率、早期 Fontan 失败（死亡、拆除或机械支持）、胸腔积液（延长住院时间 >30 天或需要再次手术干预）以及住院时间超过 30 天的影响。
总死亡率为 3.5%（37/1071），整个研究期间呈下降趋势，从 8%（1975-1990 年）降至 4%（1991-2000 年）和 1%（2001-2010 年）。在任何结局中，心外管道和侧隧道修正之间没有差异。2006 年后，仅进行心外管道，死亡率为 1.3%。左心发育不全综合征患者的比例在当前时代上升至 17%，该组胸腔积液更多（比值比，3.0；95%置信区间，1.4-6.6），平均住院时间延长 2 天。左心发育不全综合征也是复合不良早期结局（死亡、失败、胸腔积液持续时间延长或住院时间 >30 天）的独立危险因素（比值比，2.6；95%置信区间分别为 1.4-4.8）。
心外管道现在是澳大利亚和新西兰唯一进行的 Fontan 修正。即使高危病例比例较高，现代时代围手术期结局仍很好。左心发育不全综合征使胸腔积液持续时间延长和早期复合不良结局的风险增加。
