Toncu Alexandra, Rădulescu Cristina Ramona, Dorobanţu Dan, Stoica Șerban
Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK.
Department of Adult Congenital Heart Disease, Bristol Heart Institute, Bristol, UK.
Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):773-779. doi: 10.1093/icvts/ivaa002.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In [patients undergoing Fontan palliation] does [fenestration] affect [early and late postoperative outcomes]?' Altogether 509 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Current data suggest that the use of fenestration has advantages in the immediate postoperative course, with fewer complications such as pleural effusions, shorter hospitalization and decreased early Fontan failure, but comparable long-term outcomes to a non-fenestrated approach. Fenestration should be used in high-risk patients or based on the haemodynamic parameters measured before weaning from cardiopulmonary bypass. Routine use may potentially lead to additional late fenestration closure procedures in some patients, without improving long-term outcomes.
一篇心脏外科的最佳证据主题文章是根据结构化方案撰写的。所探讨的问题是：“在[接受Fontan姑息手术的患者]中，[开窗术]是否会影响[术后早期和晚期结果]？”通过报告的检索共找到509篇论文，其中11篇论文代表了回答该临床问题的最佳证据。这些论文的作者、期刊、出版日期和国家、所研究的患者群体、研究类型、相关结果和结果均列于表格中。目前的数据表明，开窗术在术后即刻过程中有优势，并发症如胸腔积液较少，住院时间较短，早期Fontan衰竭减少，但与非开窗术方法的长期结果相当。开窗术应在高危患者中使用，或根据体外循环撤机前测量的血流动力学参数使用。常规使用可能会导致一些患者后期额外的开窗关闭手术，而不会改善长期结果。
