Division of Cardiac Surgery, CHU-ME Sainte Justine, University of Montréal, Montréal, Quebec, Canada; Montréal Heart Institute, University of Montréal, Montréal, Quebec, Canada.
Division of Cardiac Surgery, CHU-ME Sainte Justine, University of Montréal, Montréal, Quebec, Canada; Montréal Heart Institute, University of Montréal, Montréal, Quebec, Canada.
Ann Thorac Surg. 2020 May;109(5):1467-1474. doi: 10.1016/j.athoracsur.2019.12.020. Epub 2020 Jan 24.
Many studies investigating fenestration in the context of Fontan procedure have been showing controversial results when it comes to whether this procedure truly improves the Surgical outcomes. The aim of this meta-analysis was to compare the early outcomes of a fenestrated (F) vs a nonfenestrated (NF) Fontan procedure.
The PubMed, EMBASE, and Cochrane Library databases were searched for articles measuring the outcomes of an F vs an NF Fontan.
A total of 19 studies were selected with a total of 4806 patients (F. 2727; NF. 2079). There was no difference in the risk of Fontan failure between both groups (odds ratio [OR], 0.95 [95% confidence interval [CI], 0.57, 1.56]; P = .83). The F group had a significantly lower need for pleural drainage (OR, 0.59 [95% CI, 0.37, 0.94]; P = .03), a lower pulmonary artery pressure (mean difference, -0.99 mm Hg [95% CI, -1.68, 0.30 mm Hg]; P = .005), and a lower oxygen saturation (mean difference, -3.07% [95% CI, -4.30%, -1.85%]; P < .001) than the NF group. There was no significant difference in the stroke occurrence between the 2 groups (OR, 1.32 [95% CI, 0.40, 4.36]; P = .65).
The Fontan fenestration effectively reduced the pulmonary pressure and the need for prolonged pleural drainage. However, the risks of Fontan failure, early death, and longer hospital stay were not modified.
许多研究在 Fontan 手术中探讨了开窗术的作用，结果显示该手术对手术结局的影响存在争议。本荟萃分析的目的是比较开窗（F）与非开窗（NF）Fontan 术的早期结果。
检索 PubMed、EMBASE 和 Cochrane 图书馆数据库，以评估 F 与 NF Fontan 术的结果。
共选择了 19 项研究，共有 4806 例患者（F 组 2727 例，NF 组 2079 例）。两组 Fontan 失败的风险无差异（比值比 [OR]，0.95 [95%置信区间 [CI]，0.57，1.56]；P =.83）。F 组的胸腔引流需求显著降低（OR，0.59 [95% CI，0.37，0.94]；P =.03），肺动脉压降低（平均差值，-0.99 毫米汞柱 [95% CI，-1.68，0.30 毫米汞柱]；P =.005），氧饱和度降低（平均差值，-3.07% [95% CI，-4.30%，-1.85%]；P <.001）。两组卒中发生率无显著差异（OR，1.32 [95% CI，0.40，4.36]；P =.65）。
Fontan 开窗术有效降低了肺动脉压和胸腔引流的需求。然而，Fontan 失败、早期死亡和住院时间延长的风险并未改变。
