Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Department of Pediatric and Adult Congenital Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2022 Feb 21;34(3):438-445. doi: 10.1093/icvts/ivab339.
Patients who have achieved Fontan circulation may require reoperation. We reviewed the outcomes of reoperation after Fontan completion and assessed the risk factors for poor outcomes.
This was a retrospective study of 106 patients undergoing open-heart reoperations after Fontan completion in 2003 at a single institution.
The mean age at reoperation was 24.6 ± 8.3 years. A history of Fontan failure or end-organ dysfunction was noted in 30 patients. The reoperations included 73 total cavopulmonary connection conversions, 29 atrioventricular or semilunar valve operations (17 with total cavopulmonary connection conversions) and 4 other operations. Eight early deaths occurred. During a median follow-up of 5.5 (0.01-16.2) years, there were 3 late deaths and 9 second cardiac operations. The 10-year survival rate after reoperation was 89.8%, and the 5-year second cardiac operation-free survival was 84.3%. The 10-year survival rates were significantly lower in patients who underwent surgery before 2011 (75.8% vs 100%), had a history of Fontan failure or end-organ dysfunction (71.7% vs 97.3%), had preoperative central venous pressure >15 mmHg (64.9% vs 96.5%) and were operated on with deep hypothermic circulatory arrest (DHCA) (60.0% vs 91.3%). A history of Fontan failure or end-organ dysfunction, preoperative central venous pressure >15 mmHg and requirement of DHCA were identified as risk factors for mortality.
Reoperation after Fontan completion resulted in excellent mid-term outcomes. A history of failed Fontan circulation and the requirement of DHCA negatively affected survival outcomes.
已建立 Fontan 循环的患者可能需要再次手术。我们回顾了 Fontan 完成后的再次手术结果，并评估了不良结果的危险因素。
这是对 2003 年在一家机构完成 Fontan 后进行心脏直视再次手术的 106 例患者的回顾性研究。
再次手术时的平均年龄为 24.6±8.3 岁。30 例患者有 Fontan 失败或终末器官功能障碍病史。再次手术包括 73 例全腔静脉肺动脉连接转换术、29 例房室瓣或半月瓣手术（17 例合并全腔静脉肺动脉连接转换术）和 4 例其他手术。8 例早期死亡。中位随访 5.5（0.01-16.2）年后，有 3 例晚期死亡和 9 例二次心脏手术。再次手术后 10 年生存率为 89.8%，5 年无二次心脏手术生存率为 84.3%。2011 年前手术、Fontan 失败或终末器官功能障碍病史、术前中心静脉压>15mmHg 和深低温停循环（DHCA）手术的患者 10 年生存率显著降低（75.8% vs 100%、71.7% vs 97.3%、64.9% vs 96.5%和 60.0% vs 91.3%）。Fontan 失败或终末器官功能障碍病史、术前中心静脉压>15mmHg 和需要 DHCA 被确定为死亡的危险因素。
Fontan 完成后的再次手术获得了良好的中期结果。Fontan 循环失败病史和需要 DHCA 对生存结果产生负面影响。
