Palacios-Macedo Alexis, Díliz-Nava Héctor, Tamariz-Cruz Orlando, García-Benítez Luis, Pérez-Juárez Fabiola, Araujo-Martínez Aric, Mier-Martínez Moisés, Corona-Villalobos Carlos, Castañuela Violeta, March Almudena, López-Terrazas Javier, Cabrera Antonio G
División de Cirugía Cardiovascular, Instituto Nacional de Pediatría, Fundación Kardias, Centro Medico ABC, Mexico City, Mexico.
Servicio de Cardiología, Instituto Nacional de Pediatría, Fundación Kardias, Centro Medico ABC, Mexico City, Mexico.
World J Pediatr Congenit Heart Surg. 2019 Sep;10(5):590-596. doi: 10.1177/2150135119862607.
Although high altitude has been considered a risk factor for the Fontan operation, and an indication for fenestration, there is a paucity of data to support its routine use. Fenestration, with its necessary right to left induced shunt, together with the lower partial pressure of oxygen found with progressive altitude, can significantly decrease hemoglobin oxygen saturation, and therefore, it would be desirable to avoid it.
To analyze immediate and medium-term results of the non-fenestrated, extracardiac, Fontan procedure at high altitude.
Retrospective analysis of data from consecutive patients who underwent non-fenestrated, extracardiac, Fontan procedure at two institutions located in Mexico City at 2,312 m (7,585 ft) and 2,691 m (8,828 ft) above sea level. High altitude was not considered a risk factor.
Thirty-nine patients were included, with a mean age of 6.7 years. Mean preoperative indexed pulmonary vascular resistance was 1.7 Wood units. Seventy-nine percent of the patients extubated in the operating room. There was one in-hospital death (2.56%) and one at follow-up. Median chest tube drainage time was 6.5 and 6 days for the right and left pleural spaces. Median oxygen saturation at discharge was 90%. At a median follow-up of six months, all survivors, except one, had good tolerance to daily life activities.
The present study shows good short- and medium-term results for the non-fenestrated, extracardiac, Fontan operation at altitudes between 2,300 and 2,700 m and might favor this strategy over fenestration to improve postoperative oxygen saturation. Further studies to examine the long-term outcomes of this approach need to be considered.
尽管高海拔被认为是实施Fontan手术的一个风险因素，也是进行开窗分流术的一个指征，但支持其常规使用的数据却很匮乏。开窗分流术会导致必然的右向左分流，再加上随着海拔升高氧分压降低，会显著降低血红蛋白氧饱和度，因此，最好避免使用该方法。
分析在高海拔地区进行非开窗、心外Fontan手术的近期和中期结果。
对在墨西哥城海拔2312米（7585英尺）和2691米（8828英尺）的两家机构接受非开窗、心外Fontan手术的连续患者的数据进行回顾性分析。高海拔未被视为风险因素。
纳入39例患者，平均年龄6.7岁。术前平均肺血管阻力指数为1.7伍德单位。79%的患者在手术室拔管。有1例院内死亡（2.56%），1例在随访期间死亡。右侧和左侧胸腔的胸管引流时间中位数分别为6.5天和6天。出院时氧饱和度中位数为90%。在中位随访6个月时，除1例幸存者外，所有幸存者对日常生活活动耐受性良好。
本研究显示，在海拔2300至2700米之间进行非开窗、心外Fontan手术具有良好的短期和中期结果，与开窗分流术相比，该策略可能更有利于提高术后氧饱和度。需要考虑进一步研究以探讨这种方法的长期结果。
