Bolin Elijah H, Maskatia Shiraz A, Tate Amanda L, Petit Christopher J
Tex Heart Inst J. 2015 Aug 1;42(4):333-40. doi: 10.14503/THIJ-14-4178. eCollection 2015 Aug.
We tested the hypothesis that later completion of the Fontan procedure is associated with improved exercise capacity in the current period of staged single-ventricle palliation. We performed a retrospective study, in Fontan patients, of exercise stress test data from April 2003 through March 2011. Patients were included if they had received staged palliations in accordance with current surgical strategy, defined as the performance of a superior cavopulmonary connection at ≤1 year of age, followed in subsequent years by Fontan completion. Patients with a pacemaker or respiratory exchange ratio <1 were excluded. Early and late Fontan groups were created on the basis of whether Fontan completion had been performed at <4 or ≥ 4 years of age. The primary predictor variable was age at Fontan completion, and the primary marker of exercise performance was the percentage of predicted maximum oxygen consumption. During the study period, 55 patients were identified (mean age, 11.7 ± 2.8 yr). Older age at Fontan completion correlated positively with higher percentages of predicted maximum oxygen consumption (R=0.286, P=0.034). Patients in whom Fontan completion was performed at ≥4 years of age had higher percentages of predicted maximum oxygen consumption than did those in whom completion was at <4 years of age (84.4 ± 21.5 vs 72.9 ± 18.1; P=0.041). Later Fontan completion might be associated with improved exercise capacity in patients palliated in accordance with contemporary surgical strategy.
在目前的单心室分期姑息治疗阶段，较晚完成Fontan手术与运动能力改善相关。我们对2003年4月至2011年3月期间Fontan患者的运动应激试验数据进行了一项回顾性研究。如果患者按照当前手术策略接受了分期姑息治疗（定义为在≤1岁时进行上腔静脉肺动脉连接，随后几年完成Fontan手术），则纳入研究。排除有起搏器或呼吸交换率<1的患者。根据Fontan手术完成时年龄<4岁或≥4岁，将患者分为早期Fontan组和晚期Fontan组。主要预测变量是Fontan手术完成时的年龄，运动表现的主要指标是预测最大耗氧量的百分比。在研究期间，共确定了55例患者（平均年龄11.7±2.8岁）。Fontan手术完成时年龄越大，预测最大耗氧量的百分比越高（R=0.286，P=0.034）。Fontan手术在≥4岁时完成的患者，其预测最大耗氧量的百分比高于在<4岁时完成手术的患者（84.4±21.5 vs 72.9±18.1；P=0.041）。按照当代手术策略进行姑息治疗的患者中，较晚完成Fontan手术可能与运动能力改善相关。
