单心室姑息治疗的全腔静脉肺动脉连接术的结果
Outcomes of total cavopulmonary connection for single ventricle palliation.
作者信息
Zou Minghui, Wang Yanfei, Cui Hujun, Ma Li, Yang Shengchun, Xia Yuansheng, Chen Weidan, Chen Xinxin
机构信息
Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.
出版信息
J Thorac Dis. 2016 Jan;8(1):43-51. doi: 10.3978/j.issn.2072-1439.2016.01.41.
BACKGROUND
The aim of this study was to review the early and mid-term outcomes of the total cavopulmonary connection (TCPC) procedure and evaluate risk factors for prolonged pleural effusions.
METHODS
The clinical records of 82 consecutive patients, who underwent a TCPC operation between January 2008 and December 2013, were reviewed for incidence of prolonged pleural effusions, duration of ventilation time and pleural drainage, length of intensive care unit (ICU) stay, and early and mid-term morbidity and mortality.
RESULTS
The median age at surgery was 3.0 years. The main single ventricle diagnoses included 18 cases of a double-inlet single ventricle, 17 cases of heterotaxy, 16 cases of tricuspid atresia, 4 cases of mitral atresia, 12 cases of unbalanced complete atrioventricular canal (CAVC), 5 cases of double-outlet right ventricle (DORV) combined with ventricular septal defect (VSD) and pulmonary stenosis (PS), 4 cases of transposition of the great arteries (TGA) combined with VSD and PS, 4 cases of corrected transposition of great arteries (cTGA) combined VSD and PS, and 2 cases of criss-cross heart. Preoperative mean pulmonary artery pressure (mPAP) was 13.66±2.21 mmHg with 23.2% (n=19) higher than 15 mmHg. A total of 61 (74.4%) patients underwent a fenestration. The perioperative mortality was 4.9%. The median duration of pleural effusion was 10 days (range, 3-80 days), and prolonged pleural effusions occurred in 16 (19.5%) patients. Multivariable analysis revealed that mPAP >15 mmHg was independently associated with prolonged pleural effusions (OR, 8.33; 95% CI, 2.33-29.74; P=0.001), and creation of a fenestration was associated with decreased odds of effusion (OR, 0.21; 95% CI, 0.06-0.74; P=0.015). Five-year estimated Kaplan-Meier survival of two-stage TCPC was significantly higher than that of one-stage group(96.7% vs. 79.7%, P=0.023). Patients with heterotaxy or obstructed totally anomalous pulmonary venous connection (TAPVC) had significantly worse mid-term survival.
CONCLUSIONS
Staged TCPC improved the early and mid-term survival of patients with a single ventricle. mPAP >15 mmHg was independently associated with prolonged pleural effusions and a fenestration significantly associated with a lower odds of effusion.
背景
本研究旨在回顾全腔静脉肺动脉连接术（TCPC）的早期和中期结果，并评估胸腔积液持续时间延长的危险因素。
方法
回顾了2008年1月至2013年12月期间连续82例行TCPC手术患者的临床记录，以了解胸腔积液持续时间延长的发生率、通气时间和胸腔引流持续时间、重症监护病房（ICU）住院时间以及早期和中期发病率及死亡率。
结果
手术时的中位年龄为3.0岁。主要的单心室诊断包括18例双入口单心室、17例内脏异位、16例三尖瓣闭锁、4例二尖瓣闭锁、12例不平衡完全性房室通道（CAVC）、5例右心室双出口（DORV）合并室间隔缺损（VSD）和肺动脉狭窄（PS）、4例大动脉转位（TGA）合并VSD和PS、4例矫正型大动脉转位（cTGA）合并VSD和PS，以及2例交叉心脏。术前平均肺动脉压（mPAP）为13.66±2.21 mmHg，其中23.2%（n = 19）高于15 mmHg。共有61例（74.4%）患者进行了开窗术。围手术期死亡率为4.9%。胸腔积液的中位持续时间为10天（范围3 - 80天），16例（19.5%）患者出现胸腔积液持续时间延长。多变量分析显示，mPAP >15 mmHg与胸腔积液持续时间延长独立相关（OR，8.33；95%CI，2.33 - 29.74；P = 0.001），而开窗术与积液几率降低相关（OR，0.21；95%CI，0.06 - 0.74；P = 0.015）。两阶段TCPC的五年估计Kaplan-Meier生存率显著高于一阶段组（96.7%对79.7%，P = 0.023）。内脏异位或完全性肺静脉异位连接（TAPVC）梗阻的患者中期生存率显著较差。
结论
分期TCPC提高了单心室患者的早期和中期生存率。mPAP >15 mmHg与胸腔积液持续时间延长独立相关，开窗术与积液几率降低显著相关。
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