Department of Pediatrics (Cardiology), University of Utah, Salt Lake City, Utah.
Department of Pediatrics (Cardiology), Stanford University, Palo Alto, Calif; Department of Bioengineering, Stanford University, Palo Alto, Calif.
J Thorac Cardiovasc Surg. 2015 Jan;149(1):239-45.e1. doi: 10.1016/j.jtcvs.2014.08.058. Epub 2014 Sep 16.
To demonstrate the technical feasibility and describe intermediate outcomes for the initial patients undergoing handcrafted, area-preserving, Y-graft modification of the Fontan procedure.
A retrospective review of a pilot study was undertaken to describe preoperative, intraoperative, and postoperative results.
Six patients underwent successful procedures and remain alive 3 to 4 years later. The median age at operation was 3.3 years, and median weight was 13.2 kg. Five operations were done without cardiopulmonary bypass and no intraoperative pressure gradients were found. Five patients were extubated by postoperative day 1, Fontan pressures were 12 to 14 mm Hg, transpulmonary gradients were 6 to 8 mm Hg, and no renal or hepatic function abnormalities were found. Length of stay was 10 to 64 days. One patient required venovenous extracorporeal membrane oxygenation for previously undiagnosed plastic bronchitis (64-day stay); another required reoperation for an incidentally diagnosed aortic thrombus (44-day stay). One patient had occlusion of a Y-graft limb noted on magnetic resonance imaging follow-up at 3 months. Catheterization showed excellent hemodynamic parameters and no Fontan obstruction. Occlusion was believed to be due to right-sided pulmonary arteriovenous malformations and widely discrepant flow (80%) to the right lung leading to low flow in the left limb.
The area-preserving, bifurcated Y-graft Fontan modification is technically feasible and shows excellent intermediate outcomes. Additional study is required to determine whether the advantages seen in the computational models will be realized in patients over the long-term, and to optimize patient selection for each of the various Fontan options now available.
展示经手工制作、区域保留、Y 型移植物修改 Fontan 手术的技术可行性，并描述初始患者的中期结果。
对一项试点研究进行回顾性分析，以描述术前、术中及术后结果。
6 例患者成功进行了手术，4 年后仍存活。手术时的中位年龄为 3.3 岁，体重中位数为 13.2kg。5 例手术在无体外循环的情况下进行，术中未发现压力梯度。5 例患者在术后第 1 天拔管，Fontan 压力为 12-14mmHg，跨肺梯度为 6-8mmHg，未发现肾功能或肝功能异常。住院时间为 10-64 天。1 例患者因先前未诊断的塑料性支气管炎需要静脉-静脉体外膜肺氧合（住院 64 天）；另 1 例患者因意外诊断的主动脉血栓需要再次手术（住院 44 天）。1 例患者在 3 个月的磁共振成像随访中发现 Y 型移植物分支闭塞。导管检查显示血流动力学参数良好，无 Fontan 梗阻。闭塞被认为是由于右侧肺动静脉畸形和明显不同的血流（80%）到右肺导致左侧分支低流量所致。
区域保留、分叉 Y 型移植物 Fontan 手术修改是可行的，中期结果良好。需要进一步研究，以确定计算模型中看到的优势是否会在长期患者中实现，并优化各种 Fontan 选择的患者选择。
