Liu Xiaobing, Yuan Haiyun, Chen Jimei, Cen Jianzheng, Nie Zhiqiang, Xu Gang, Wen Shusheng, Zhuang Jian
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Epidemiology, Guangdong Cardiovascular Institute, WHO Collaborating Center for Research and Training in Cardiovascular Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Eur J Cardiothorac Surg. 2020 Apr 1;57(4):628-634. doi: 10.1093/ejcts/ezz310.
The modified extracardiac Fontan of direct total cavopulmonary connection (dTCPC) with entirely autologous vessels is a better solution in selected patients with functionally univentricular hearts because it combines the advantages of a tubular connection and of full growth potential. We investigated the mid-term to long-term outcomes of the physical condition of patients who had the dTCPC and assessed the growth potential of the autologous dTCPC pathway.
From July 2005 to June 2014, 31 patients, aged 1.8-14.0 years, underwent a modified extracardiac Fontan with dTCPC at our institution. Twenty-two patients underwent a 1-stage dTCPC and 9 patients underwent a 2-stage dTCPC. The preoperative and postoperative data were reviewed retrospectively.
There were 17 (54.8%) boys and 14 (45.2%) girls, with a median age of 6.4 years (range 1.8-14.0 years) and a mean weight of 17.8 kg (range 9-41 kg). The mean follow-up period was 6.0 years (range 2.1-10.2 years). There was 1 early death and 2 late deaths. The event-free survival rate for the 31 patients was 88.9% at 10 years during the follow-up period. Late protein-losing enteropathy, thromboembolism, arrhythmia or heart failure were not observed. There was a significant difference between the preoperative and postoperative data for body mass index and the diameters of the autologous dTCPC pathway and pulmonary artery branches, confirming that the growth potential of the autologous dTCPC pathway was realized.
The dTCPC procedure could be performed with satisfactory midterm to long-term outcomes in selected patients. It has the potential of retaining the advantage of the extracardiac Fontan operation together with the potential for growth and the avoidance of prosthetic materials.
采用完全自体血管的改良心外Fontan直接全腔肺连接术（dTCPC），对于特定的功能性单心室心脏患者而言是一种更好的解决方案，因为它兼具管状连接和充分生长潜力的优势。我们研究了接受dTCPC治疗患者身体状况的中长期结局，并评估了自体dTCPC通路的生长潜力。
2005年7月至2014年6月，31例年龄在1.8至14.0岁的患者在我院接受了改良心外Fontan联合dTCPC手术。22例患者接受了一期dTCPC，9例患者接受了二期dTCPC。对术前和术后数据进行回顾性分析。
男性17例（54.8%），女性14例（45.2%），中位年龄6.4岁（范围1.8至14.0岁），平均体重17.8 kg（范围9至41 kg）。平均随访期为6.0年（范围2.1至10.2年）。有1例早期死亡和2例晚期死亡。31例患者在随访期间10年的无事件生存率为88.9%。未观察到晚期蛋白丢失性肠病、血栓栓塞、心律失常或心力衰竭。术前和术后体重指数以及自体dTCPC通路和肺动脉分支直径的数据存在显著差异，证实自体dTCPC通路的生长潜力得以实现。
对于特定患者，dTCPC手术可获得令人满意的中长期结局。它有可能保留心外Fontan手术的优势，同时具备生长潜力并避免使用人工材料。
