Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Jerusalem, Israel.
Pediatric Cardiology, Hadassah University Medical Center, Jerusalem, Israel.
World J Pediatr Congenit Heart Surg. 2022 May;13(3):346-352. doi: 10.1177/21501351221081246.
Single ventricle heart disease comprises a wide variety of critical heart defects that lead to the provision of systemic cardiac output by one dominant ventricle. It requires staged surgical palliation that culminates in Fontan circulation. Dominant ventricular morphology in single ventricle patients reportedly has an impact on postoperative morbidity and mortality with varying results. The objectives of this study were to examine the association between ventricular morphology and the early postoperative course after the Fontan procedure.
A retrospective cohort study in a tertiary referral pediatric medical center that included 98 consecutive patients who underwent Fontan procedure between October 2009 and May 2016. Postoperative outcomes were compared between patients with left ventricular morphology and those with right ventricular morphology (crude effect and regression analysis).
Patients with right ventricular morphology had longer postoperative hospitalizations compared to patients with left ventricular morphology (26.5 days vs 18.2 days, respectively, = .028), higher postoperative maximal vasoactive-inotropic scores (25.6 vs 12.4, = .02), higher serum lactate levels (7.7 mmol/L vs 6.4 mmol/L, = .03), higher proportions of ventilation throughout 24 h or more (16 patients [38%] vs 8 patients [14%], = .009), higher proportions of ventricular dysfunction (12 patients [29%] vs 5 patients [9%], = .0001), and lower blood oxygen saturation levels at discharge (87% vs 92%, = .03).
The Fontan procedure in patients with right ventricular morphology is associated with longer postoperative hospitalization and worse early postoperative characteristics (ventricular dysfunction and atrioventricular valve regurgitation) as well as higher rates of early, transient signs of sub-optimal postoperative hemodynamics compared to those with left ventricular morphology.
单心室心脏病包括多种严重的心脏缺陷，这些缺陷导致一个主要心室提供全身心输出量。它需要分阶段的手术姑息治疗，最终形成 Fontan 循环。据报道，单心室患者的主要心室形态对术后发病率和死亡率有影响，但结果不一。本研究的目的是研究 Fontan 手术后心室形态与早期术后过程之间的关系。
这是一项在三级转诊儿科医疗中心进行的回顾性队列研究，共纳入 98 例 2009 年 10 月至 2016 年 5 月期间接受 Fontan 手术的连续患者。比较左心室形态和右心室形态患者的术后结局（原始效应和回归分析）。
与左心室形态患者相比，右心室形态患者的术后住院时间更长（分别为 26.5 天和 18.2 天， = .028），术后最大血管活性-正性肌力评分更高（分别为 25.6 和 12.4， = .02），血清乳酸水平更高（分别为 7.7mmol/L 和 6.4mmol/L， = .03），24 小时或更长时间通气的比例更高（分别为 16 例 [38%] 和 8 例 [14%]， = .009），心室功能障碍的比例更高（分别为 12 例 [29%] 和 5 例 [9%]， = .0001），出院时血氧饱和度水平更低（分别为 87%和 92%， = .03）。
与左心室形态患者相比，右心室形态患者的 Fontan 手术与术后住院时间延长以及更差的早期术后特征（心室功能障碍和房室瓣反流）有关，与左心室形态患者相比，早期短暂的术后血流动力学不佳的迹象发生率更高。
