Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Division of Cardiothoracic Surgery, Indiana University School of Medicine, James Whitcomb Riley Children's Hospital, Indianapolis, Indiana.
Ann Thorac Surg. 2014 Mar;97(3):924-31; discussion 930-1. doi: 10.1016/j.athoracsur.2013.11.041. Epub 2014 Feb 2.
The purpose of this study is to compare morbidity and mortality between fenestrated (F, 61 patients) and nonfenestrated (NF, 54 patients) extracardiac Fontan patients during two eras from July 1995 to December 2010: era 1(1995 to 2004) and era 2 (2005 to 2010).
Variables evaluated included morphology, hemodynamics, chest tube volume and duration, intensive care and hospital stay, oxygen saturation, neurologic events, rhythm, and readmissions for chylous effusions. Follow-up in 114 hospital survivors was longer in the nonfenestrated cohort (F, 5.0 ± 3.3 years; NF, 7.1 ± 4.6 years; p < 0.005).
Cohorts were similar in body size, morphology, and hemodynamics. Fenestration in hypoplastic left heart syndrome was appreciatively higher in era 2. Bypass time (F, 69 ± 27 minutes; NF, 57 ± 21 minutes) and conduit size (F, 18.8 mm; NF, 19.1 mm) were similar. There was 1 early nonfenestrated Fontan death (1 of 54; 2%) and 4 late deaths (F, 2 of 61, 5%; NF, 2 of 53, 4%; p = 0.86). Room air saturation was higher in NF patients (F, 89%; NF, 94%; p < 0.05). Total chest tube volume was similar, but fenestration was associated with greater chest tube drainage among hypoplastic left heart patients (HLHS, 5,582 ± 3,286 mL; non-HLHS, 3,405 ± 2,533 mL; p = 0.06; odds ratio; 2.0). Readmission to treat chylous effusions, loss of sinus rhythm, actuarial freedom from death, all neurologic events, pacemaker insertion, and Fontan takedown were similar in both cohorts.
Fenestration was associated with lower discharge oxygen saturations, but late outcomes in fenestrated and nonfenestrated patients are equivalent.
本研究旨在比较 1995 年 7 月至 2010 年 12 月两个时期（1995 年至 2004 年的时期 1 和 2005 年至 2010 年的时期 2）经心外腔 Fontan 手术的有窗（F 组，61 例）和无窗（NF 组，54 例）患者的发病率和死亡率。
评估的变量包括形态、血液动力学、胸腔引流管量和持续时间、重症监护和住院时间、氧饱和度、神经事件、节律以及乳糜胸再入院。在 114 例住院幸存者中，NF 组的随访时间更长（F 组：5.0 ± 3.3 年；NF 组：7.1 ± 4.6 年；p < 0.005）。
两组在体型、形态和血液动力学方面相似。在发育不全左心综合征中，二期有窗的比例明显较高。体外循环时间（F 组：69 ± 27 分钟；NF 组：57 ± 21 分钟）和管道大小（F 组：18.8 毫米；NF 组：19.1 毫米）相似。NF 组有 1 例早期 Fontan 死亡（54 例中的 1 例；2%）和 4 例晚期死亡（F 组：61 例中的 2 例；5%；NF 组：53 例中的 2 例；4%；p = 0.86）。NF 组患者的空气饱和度更高（F 组：89%；NF 组：94%；p < 0.05）。总的胸腔引流管量相似，但在发育不全左心患者中，有窗与更大的胸腔引流管引流有关（HLHS：5582 ± 3286 mL；非 HLHS：3405 ± 2533 mL；p = 0.06；比值比；2.0）。NF 组和 F 组在因乳糜胸再入院、窦性节律丧失、死亡率、所有神经事件、起搏器植入和 Fontan 拆除方面的再入院率相似。
有窗与较低的出院氧饱和度有关，但有窗和无窗患者的晚期结果是相当的。
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