Januszewska Katarzyna, Schuh Anna, Lehner Anja, Dalla-Pozza Robert, Malec Edward
Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Geb. A1, 48149, Muenster, Germany.
Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian-University, Klinikum Großhadern, Marchioninistr.15, 81377, Munich, Germany.
Pediatr Cardiol. 2017 Apr;38(4):712-718. doi: 10.1007/s00246-017-1571-3. Epub 2017 Feb 10.
The goal of the study was to compare the early postoperative course after fenestrated lateral atrial tunnel (LT) and non-fenestrated extracardiac conduit (EC) Fontan operation (FO) in a single center where both techniques were parallelly used. Between 2004 and 2012, 56(32.7%) children underwent LT and 113(66.1%) EC FO. The mean age was 3.7 ± 2.9 years and mean weight was 14.6 ± 7.3 kg. The most common malformation was hypoplastic left heart syndrome (50.9%). The general approach was to perform LT in children after hemi-Fontan operation and EC in patients after Glenn anastomosis. Medical records were retrospectively reviewed. The hospital survival was 100%. In EC group, cardiopulmonary bypass time (CPB) was shorter (p = 0.004) and less patients needed aortic cross-clamping (p < 0.001). Children after EC stayed longer in the hospital (p = 0.016) and manifested more often prolonged effusions (p = 0.038). The incidence of all forms of junctional rhythm was higher in the LT group, early postoperatively (p < 0.001), during hospitalization (p = 0.004) and at discharge (p < 0.001). Children after LT required more often temporary pacemaker stimulation (p < 0.001). Patients without postoperative normofrequent sinus rhythm had longer CPB time (p = 0.008) and were more often operated on with aortic cross-clamping (p = 0.028). Lateral atrial tunnel Fontan operation with fenestration facilitates early adaptation to the total passive pulmonary flow, but predisposes the patients to the loss of sinus rhythm. The crucial role in the preservation of sinus rhythm plays the last step of the multistage surgery of the single ventricle malformations, probably not only the surgical technique but also factors associated with the cardiopulmonary bypass.
本研究的目的是在一个同时平行使用开窗式侧房隧道（LT）和非开窗式心外管道（EC）Fontan手术（FO）两种技术的单中心，比较这两种手术方式术后早期的病程。2004年至2012年期间，56例（32.7%）儿童接受了LT手术，113例（66.1%）接受了EC-FO手术。平均年龄为3.7±2.9岁，平均体重为14.6±7.3千克。最常见的畸形是左心发育不全综合征（50.9%）。一般的手术方法是在半Fontan手术后的儿童中进行LT手术，在Glenn吻合术后的患者中进行EC手术。对病历进行了回顾性分析。住院生存率为100%。在EC组中，体外循环时间（CPB）较短（p = 0.004），需要主动脉阻断的患者较少（p < 0.001）。EC手术后的儿童住院时间更长（p = 0.016），积液延长的情况更常见（p = 0.038）。LT组术后早期（p < 0.001）、住院期间（p = 0.004）和出院时（p < 0.001）各种形式的交界性心律发生率更高。LT手术后的儿童更常需要临时起搏器刺激（p < 0.001）。术后无正常频率窦性心律的患者CPB时间更长（p = 0.008），且更常接受主动脉阻断手术（p = 0.028）。开窗式侧房隧道Fontan手术有助于早期适应完全被动肺血流，但使患者更容易出现窦性心律丧失。在保留窦性心律方面，单心室畸形多阶段手术的最后一步起着关键作用，可能不仅涉及手术技术，还与体外循环相关因素有关。
