Zhang Tao, Shi Yisheng, Wu Kaihong, Hua Zhongdong, Li Shoujun, Hu Shengshou, Zhang Hao
Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China; Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; Department of Cardio-Thoracic Surgery, Shouguang People's Hospital, Shandong, China.
Department of Echocardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China.
Ann Thorac Surg. 2016 Apr;101(4):1530-8. doi: 10.1016/j.athoracsur.2015.10.071. Epub 2016 Jan 12.
Given the low rate of Fontan completion, an aggressive policy for maintaining antegrade pulmonary blood flow (AnPBF) during the bidirectional Glenn procedure (BDG) was developed for the functional single ventricle.
From 2008 to 2013, 294 patients who underwent the BDG were divided into two groups: group 1 (uncontrolled AnPBF, n = 270) and group 2 (controlled AnPBF, n = 24). Pulmonary artery banding was performed because of the high central venous pressure in group 2. In group 1, the patients who underwent BDG from 2008 to 2012 were further divided into group DF (delayed Fontan completion, n = 109) and group FC (Fontan completion, n = 42).
The Fontan completion rate was 16.3%, and the average interval time was 2.2 ± 1.1 years. The delay of Fontan completion did not reduce body weight gain or the survival rate. Furthermore, oxygen saturation was slightly reduced in group DF. Although no impairments of heart function were observed, the uncontrolled AnPBF in group DF resulted in an increase in ventricular end-diastolic diameter and aggravation of atrioventricular valve regurgitation over 24 months after BDG. Logistic regression analysis revealed that systemic right ventricular morphology was a risk factor for the aggravation of valve regurgitation.
The low Fontan achievement rate is a critical issue in China. Although the patients with delayed Fontan completion exhibited an acceptable survival rate and acceptable body weight gain, uncontrolled AnPBF was associated with ventricular enlargement and aggravation of valve regurgitation. Strategies for improving the Fontan completion rate in China should be explored and could benefit outcomes.
鉴于Fontan手术完成率较低，针对功能性单心室，在双向格林手术（BDG）期间制定了一项积极的维持顺行性肺血流（AnPBF）的策略。
2008年至2013年，294例行BDG手术的患者被分为两组：第1组（AnPBF未控制组，n = 270）和第2组（AnPBF控制组，n = 24）。第2组因中心静脉压高而进行了肺动脉环扎术。在第1组中，2008年至2012年接受BDG手术的患者进一步分为DF组（Fontan手术延迟完成组，n = 109）和FC组（Fontan手术完成组，n = 42）。
Fontan手术完成率为16.3%，平均间隔时间为2.2±1.1年。Fontan手术延迟完成并未降低体重增加或生存率。此外，DF组的血氧饱和度略有降低。虽然未观察到心功能受损，但DF组未控制的AnPBF导致BDG术后24个月心室舒张末期直径增加和房室瓣反流加重。逻辑回归分析显示，系统性右心室形态是瓣膜反流加重的危险因素。
Fontan手术低完成率是中国的一个关键问题。虽然Fontan手术延迟完成的患者表现出可接受的生存率和体重增加，但未控制的AnPBF与心室扩大和瓣膜反流加重有关。应探索提高中国Fontan手术完成率的策略，这可能有益于改善预后。
