Tabarsi Nazlee, Guan Meijiao, Simmonds Jacob, Toma Mustafa, Kiess Marla, Tsang Victor, Ruygrok Peter, Konstantinov Igor, Shi William, Grewal Jasmine
Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, Great Ormond Street Hospital for Children, London, United Kingdom.
Am J Cardiol. 2017 Apr 15;119(8):1269-1274. doi: 10.1016/j.amjcard.2017.01.001. Epub 2017 Jan 25.
The Fontan procedure is increasingly being used to palliate univentricular physiology. It is a complex anatomic and physiologic repair that can fail at any age, often leaving heart transplantation as the only remaining solution. A meta-analysis was performed to achieve the aim of systematically evaluating the existing evidence for survival after heart transplantation in patients who have undergone a Fontan palliation. MEDLINE, Embase, PubMed, and Web of Science were searched for original research studies. The primary outcome was mortality at 1 and 5 years after transplantation. Five hundred eighty-two records were screened, after the removal of duplicates, 12 retrospective observational studies were selected for inclusion in our meta-analysis. This encompassed a total of 351 Fontan patients undergoing heart transplantation. Mean age was 14 years (range 7 to 24 years) and 65% were men. One- and 5-year survival rates after heart transplantation were found to be 80.3% (95% CI 75.9% to 84.2%) and 71.2% (95% CI 66.3% to 75.7%), respectively. No significant association was found between age, gender, and pulmonary pressures and 1-year mortality. In conclusion, in the largest analysis to date, we found that heart transplantation in younger patients after Fontan procedure has an acceptable early and mid-term mortality. It is comparable to published mortality data of heart transplantation for other forms of congenital heart disease. Heart transplantation in the younger failing Fontan population appears to be a reasonable option when all other avenues have been exhausted and appropriate screening has taken place.
Fontan手术越来越多地被用于缓解单心室生理功能。它是一种复杂的解剖和生理修复手术，在任何年龄都可能失败，常常使心脏移植成为唯一剩下的解决办法。进行了一项荟萃分析，以系统评估接受Fontan姑息治疗的患者心脏移植后生存情况的现有证据。检索了MEDLINE、Embase、PubMed和科学网中的原始研究。主要结局是移植后1年和5年的死亡率。筛选了582条记录，去除重复记录后，选择了12项回顾性观察性研究纳入我们的荟萃分析。这总共包括351例接受心脏移植的Fontan患者。平均年龄为14岁（范围7至24岁），65%为男性。发现心脏移植后1年和5年生存率分别为80.3%（95%CI 75.9%至84.2%）和71.2%（95%CI 66.3%至75.7%）。未发现年龄、性别、肺压力与1年死亡率之间存在显著关联。总之，在迄今为止最大规模的分析中，我们发现Fontan手术后年轻患者的心脏移植具有可接受的早期和中期死亡率。它与其他形式先天性心脏病心脏移植已发表的死亡率数据相当。当所有其他途径都已用尽且进行了适当筛查时，年轻的Fontan功能衰竭患者进行心脏移植似乎是一个合理的选择。
