Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Eur J Cardiothorac Surg. 2021 Nov 2;60(5):1074-1081. doi: 10.1093/ejcts/ezab194.
The role of an additional ventricle in patients with a functional single ventricle undergoing the Fontan operation has been debated due to conflicting data. Our goal was to report our experience with Fontan circulation for complex congenital heart disease, with a focus on the influence that an additional ventricular chamber may have on early and long-term clinical outcomes.
We performed a retrospective clinical study including all patients undergoing the Fontan procedure between 1978 and 2019. Clinical data were retrieved from our institutional database. A 'biventricular' Fontan (BVF) was defined as that performed in a patient with single ventricle anomaly where an additional diminutive ventricular cavity was present at echocardiographic evaluation.
A total of 210 consecutive patients with functional single ventricle were included. Among these, 46 had BVF (21.9%). Early complications occurred in 42 patients (20.0%; 11 in BVF vs 31 in univentricular Fontan; P = 0.53) There were 18 early deaths (8.6%) with no difference between the groups. At a median follow-up of 12.7 years (interquartile range 5.4-20.7), there were no significant differences in late mortality, whereas cardiac rhythm disturbances resulted more frequently in univentricular Fontan (P = 0.018). Statistical analysis showed an equal distribution of BVF across time (P = 0.620), and there were no significant differences in terms of early and late survival (P = 0.53 and P = 0.72, respectively) or morbidity (P = 0.45 and P = 0.80, respectively).
A secondary ventricle in Fontan circulation is not significantly related to any clinical disadvantage in terms of survival or onset of complications. However, the immediate postoperative course may be influenced negatively by the presence of an additional secondary ventricle.
由于数据相互矛盾，在接受 Fontan 手术的功能性单心室患者中，额外心室的作用一直存在争议。我们的目标是报告我们在复杂先天性心脏病中进行 Fontan 循环的经验，重点关注额外心室腔可能对早期和长期临床结果的影响。
我们进行了一项回顾性临床研究，纳入了 1978 年至 2019 年间接受 Fontan 手术的所有患者。临床数据从我们的机构数据库中检索。“双心室”Fontan（BVF）定义为在超声心动图评估中存在单个心室畸形且存在另一个小心室腔的患者中进行的 Fontan。
共纳入 210 例功能性单心室连续患者。其中，46 例接受 BVF（21.9%）。42 例（20.0%；BVF 组 11 例，单心室 Fontan 组 31 例；P=0.53）发生早期并发症。共有 18 例早期死亡（8.6%），两组间无差异。中位随访 12.7 年（四分位距 5.4-20.7），晚期死亡率无显著差异，而单心室 Fontan 更常出现心律失常（P=0.018）。统计分析显示 BVF 在时间上的分布均等（P=0.620），早期和晚期生存率（P=0.53 和 P=0.72）或发病率（P=0.45 和 P=0.80）无显著差异。
Fontan 循环中的次级心室在生存率或并发症发生方面与任何临床劣势均无显著相关性。然而，额外次级心室的存在可能会对术后即刻过程产生负面影响。
