单心室心脏中Fontan系统的失败与心脏移植的死亡风险：一项系统评价和荟萃分析

Failures of the Fontan System in Univentricular Hearts and Mortality Risk in Heart Transplantation: A Systematic Review and Meta-Analysis.

作者信息

Márquez-González Horacio, Hernández-Vásquez Jose Gustavo, Del Valle-Lom Montserrat, Yáñez-Gutiérrez Lucelli, Klünder-Klünder Miguel, Almeida-Gutiérrez Eduardo, Koretzky Solange Gabriela

机构信息

Department of Clinical Research, Federico Gómez Children's Hospital, Mexico City 06720, Mexico.

Centro Médico Nacional Siglo XXI, IMSS, Department Congenital Heart Diseases, Mexico City 06720, Mexico.

出版信息

Life (Basel). 2021 Dec 8;11(12):1363. doi: 10.3390/life11121363.

DOI:10.3390/life11121363

PMID:34947894

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8709145/

Abstract

The Fontan procedure (FP) is the standard surgical treatment for Univentricular heart diseases. Over time, the Fontan system fails, leading to pathologies such as protein-losing enteropathy (PLE), plastic bronchitis (PB), and heart failure (HF). FP should be considered as a transitional step to the final treatment: heart transplantation (HT). This systematic review and meta-analysis aims to establish the risk of death following HT according to the presence of FP complications. There was a total of 691 transplanted patients in the 18 articles, immediate survival 88% ( = 448), survival from 1 to 5 years of 78% ( = 427) and survival from 5.1 to 10 years of 69% ( = 208), >10 years 61% ( = 109). The relative risk (RR) was 1.12 for PLE (95% confidence interval [CI] = 0.89-1.40, = 0.34), 1.03 for HF (0.7-1.51, = 0.88), 0.70 for Arrhythmias (0.39-1.24, = 0.22), 0.46 for PB (0.08-2.72, = 0.39), and 5.81 for CKD (1.70-19.88, = 0.005). In patients with two or more failures, the RR was 1.94 (0.99-3.81, = 0.05). After FP, the risk of death after HT is associated with CKD and with the presence of two or more failures.

摘要

Fontan手术（FP）是单心室心脏病的标准外科治疗方法。随着时间的推移，Fontan系统会失效，导致蛋白质丢失性肠病（PLE）、塑料支气管炎（PB）和心力衰竭（HF）等病理状况。FP应被视为最终治疗方法——心脏移植（HT）的过渡步骤。本系统评价和荟萃分析旨在确定根据FP并发症的存在情况进行HT后的死亡风险。18篇文章中共有691例移植患者，即刻生存率为88%（n = 448），1至5年生存率为78%（n = 427），5.1至10年生存率为69%（n = 208），>10年生存率为61%（n = 109）。PLE的相对风险（RR）为1.12（95%置信区间[CI]=0.89 - 1.40，P = 0.34），HF为1.03（0.7 - 1.51，P = 0.88），心律失常为0.70（0.39 - 1.24，P = 0.22），PB为0.46（0.08 - 2.72，P = 0.39），慢性肾脏病（CKD）为5.81（1.70 - 19.88，P = 0.005）。在有两种或更多种功能衰竭的患者中，RR为1.94（0.99 - 3.81，P = 0.05）。FP后，HT后的死亡风险与CKD以及两种或更多种功能衰竭的存在有关。