Talwar Sachin, Kumar Manikala Vinod, Sreenivas Vishnubhatla, Gupta Vishwa Prakash, Choudhary Shiv Kumary, Airan Balram
Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Ann Pediatr Cardiol. 2018 Jan-Apr;11(1):40-47. doi: 10.4103/apc.APC_43_17.
The optimal timing, need for primary/staged procedure in patients undergoing univentricular palliation, is debatable.
We performed this study to assess the exercise performance of patients undergoing various forms of univentricular palliation.
This was a retrospective, prospective comparative study conducted at a multispecialty tertiary referral center.
Between January 2012 and June 2015, 117 patients undergoing either bidirectional Glenn (BDG) ( = 43) or Fontan (total cavopulmonary connection [TCPC]) ( = 74) underwent exercise testing.
Comparisons between subgroups for continuous data were made with Student's -test if normally distributed and Wilcoxon rank-sum test otherwise. Tests between subgroups for qualitative data were made with Pearson's Chi-square test.
Patients who underwent BDG with open antegrade pulmonary blood flow (APBF) had higher saturations (oxygen saturation [SpO]) compared to those without it (87.5 ± 5.0% vs. 81.1 ± 4.8%; = 0.0001). However, we found no differences in exercise parameters of patients undergoing BDG with or without APBF. Extracardiac TCPC ( = 42) patients demonstrated better exercise capacity (15.0 ± 7.7 vs. 11.2 ± 6.2 min; = 0.02) and increased SpO on exercise (87.0 ± 8.0% vs. 83.4 ± 7.6%; ≤ 0.05) compared to lateral tunnel TCPC ( = 32). Fenestrated TCPC ( = 30) patients had higher exercise capacity reflected by higher metabolic equivalents (METs) consumption (6.4 ± 2.3 vs. 5.2 ± 2.0 METs, = 0.02), fewer pleural effusions (7.0 ± 3.2 vs. 9.2 ± 6.2 days, ≤ 0.05), and lower hospital stay (9.5 ± 4.0 vs. 12.7 ± 7.7 days, = 0.04) compared to nonfenestrated TCPC ( = 44) patients.
We observed no differences in exercise parameters of patients undergoing BDG with or without APBF. Extracardiac TCPC patients had better exercise capacity but longer postoperative hospital stay and pleural effusions than patients with lateral tunnel Fontan. Fenestrated TCPC patients seemed to fare better than nonfenestrated ones. Patients undergoing TCPC had better exercise capacity than patients undergoing BDG alone.
对于接受单心室姑息治疗的患者，最佳治疗时机以及是否需要一期/分期手术存在争议。
我们开展这项研究以评估接受各种形式单心室姑息治疗患者的运动能力。
这是一项在多专科三级转诊中心进行的回顾性、前瞻性对比研究。
在2012年1月至2015年6月期间，117例接受双向格林分流术（BDG）（n = 43）或Fontan手术（全腔静脉肺动脉连接术[TCPC]）（n = 74）的患者接受了运动测试。
对于连续数据，若呈正态分布，则采用学生t检验比较亚组间差异；否则采用Wilcoxon秩和检验。对于定性数据，采用Pearson卡方检验比较亚组间差异。
与未开通顺行肺血流（APBF）的患者相比，开通APBF的BDG患者具有更高的血氧饱和度（氧饱和度[SpO₂]）（87.5±5.0% 对 81.1±4.8%；P = 0.0001）。然而，我们发现开通或未开通APBF的BDG患者在运动参数方面并无差异。与侧隧道TCPC（n = 32）患者相比，心外TCPC（n = 42）患者表现出更好的运动能力（15.0±7.7对11.2±6.2分钟；P = 0.02），且运动时SpO₂升高（87.0±8.0% 对 �3.4±7.6%；P≤0.05）。与非开窗TCPC（n = 44）患者相比，开窗TCPC（n = 30）患者具有更高的运动能力，表现为更高的代谢当量（METs）消耗（6.4±2.3对5.2±2.0 METs，P = 0.02）、更少的胸腔积液（7.0±3.2对9.2±6.2天，P≤0.05）以及更短的住院时间（9.5±4.0对12.7±7.7天，P = 0.04）。
我们观察到开通或未开通APBF的BDG患者在运动参数方面并无差异。心外TCPC患者比侧隧道Fontan患者具有更好的运动能力，但术后住院时间更长且胸腔积液更多。开窗TCPC患者似乎比非开窗患者情况更好。接受TCPC的患者比仅接受BDG的患者具有更好的运动能力。
