Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Int J Cardiol. 2021 Feb 15;325:56-61. doi: 10.1016/j.ijcard.2020.10.056. Epub 2020 Oct 23.
Fontan outcomes data from large volume Middle Eastern Centres are lacking. We report our experience after the Fontan operation from a tertiary cardiac centre in Saudi Arabia.
All 458 consecutive patients who had Fontan surgery 1986 through 2015 at the Prince Sultan Cardiac Centre, Riyadh [PSCC], Saudi Arabia, were evaluated for baseline, early and late post-operative outcomes and their uni and multivariate determinants.
The mean age at Fontan operation was 7 years [IQR 4.8-9.0]. The most common anatomic diagnoses were tricuspid atresia (104 [23%]) and double-inlet left ventricle (81 [18%]). Only 3 patients in the present series had hypoplastic left heart syndrome [HLHS]. Early mortality [i.e. during Fontan surgical admission] was 3.1%. At late follow-, 35 (8%) patients were lost to follow up. The 1, 5, 10, 20 and 30 year survival was 96%, 94%, 93% and 85%, respectively. In the modern surgical era, 5, 10 and 15 year survival were 96%, 95% and 93% respectively. Univariate determinants of death or transplant were hypoalbuminemia, elevated NtProBNP >500, surgical era prior to 1999, the lack of Fontan fenestration, and prior atriopulmonary Fontan [APF] procedure. On multivariate analysis, surgical era before 1999 and prior APF procedure were independently associated with death or transplant.
Fontan patients from this large volume Middle Eastern centre have comparable early and late mortality outcomes compared to prior published reports. Rigorous selection criteria at the time of Fontan, and Fontan specific dedicated care teams are likely contributors to this success.
目前缺乏大型中东中心的 Fontan 手术结果数据。我们报告了在沙特阿拉伯利雅得的一家三级心脏中心进行 Fontan 手术后的经验。
评估了 1986 年至 2015 年期间在沙特阿拉伯利雅得王子苏丹心脏中心接受 Fontan 手术的 458 例连续患者的基线、早期和晚期术后结果及其单因素和多因素决定因素。
Fontan 手术时的平均年龄为 7 岁[IQR 4.8-9.0]。最常见的解剖学诊断是三尖瓣闭锁（104 例[23%]）和双入口左心室（81 例[18%]）。本研究中仅有 3 例患者患有左心发育不全综合征[HLHS]。早期死亡率[即在 Fontan 手术期间]为 3.1%。在晚期随访中，有 35 例（8%）患者失访。1、5、10、20 和 30 年生存率分别为 96%、94%、93%和 85%。在现代手术时代，5、10 和 15 年生存率分别为 96%、95%和 93%。死亡或移植的单因素决定因素是低白蛋白血症、NtProBNP 升高>500、1999 年前的手术时代、Fontan 开窗术缺失和先前的房肺 Fontan[APF]手术。多因素分析显示，1999 年前的手术时代和先前的 APF 手术与死亡或移植独立相关。
来自这个大型中东中心的 Fontan 患者的早期和晚期死亡率与之前发表的报告相当。在进行 Fontan 手术时严格的选择标准，以及专门的 Fontan 特定护理团队，可能是取得这一成功的原因。
