Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Cardiac Surgery, Royal Melbourne Hospital, Melbourne, Australia.
Ann Thorac Surg. 2023 Aug;116(2):366-372. doi: 10.1016/j.athoracsur.2022.10.015. Epub 2022 Oct 23.
The results of the Kawashima operation are incompletely defined. Furthermore, optimal timing of Kawashima operation, an important consideration when managing desaturated young infants awaiting surgery, remains unclear. We reviewed our outcomes of Kawashima operation, with a focus on the impact of age.
We conducted a retrospective review of patients who underwent Kawashima operation from 1990 to 2020.
Thirty patients underwent Kawashima operation at a median age of 11.7 months (interquartile range, 4.4-27.4). Left isomerism was present in 27 patients (90%). There were no early deaths. There were 2 patients (6.7%) who had Kawashima takedown, both attributed to hypoxia. Fontan completion was achieved in 25 patients (83%). Overall freedom from death and transplantation at 20 years was 67% (95% CI, 32%-87%). Freedom from death and transplantation at 10 years was 100% for children 3 to 6 months of age at the time of Kawashima, compared with 86.4% for older children (P = 1.0). However, children aged 3 to 6 months had longer ventilation time (P = .01), intensive care stays (P = .03), and hospital stays (P = .05). Freedom from death or transplantation at 20 years among those who had concomitant common atrioventricular valve repair was 33%, vs 79% for those who did not undergo common atrioventricular valve repair (P = .02).
Kawashima operation can be performed with low operative risk and acceptable long-term outcomes. Performing Kawashima operation on a patient aged less than 6 months does not affect survival, but is associated with increased morbidity. Need for common atrioventricular valve operation carries significant risk of mortality, and more effective techniques for atrioventricular valve repair are required.
川岛手术的结果尚未完全明确。此外，对于等待手术的低氧年轻婴儿，川岛手术的最佳时机是一个重要的考虑因素，目前仍不清楚。我们回顾了川岛手术的结果，重点关注年龄的影响。
我们对 1990 年至 2020 年期间接受川岛手术的患者进行了回顾性研究。
30 名患者在中位年龄 11.7 个月（四分位距，4.4-27.4）时接受川岛手术。27 名患者（90%）存在左位异构。无早期死亡。有 2 名患者（6.7%）行川岛术松解，均归因于缺氧。25 名患者（83%）完成了 Fontan 手术。20 年时，无死亡和移植的总体生存率为 67%（95%CI，32%-87%）。川岛手术时年龄为 3 至 6 个月的儿童，10 年时无死亡和移植的生存率为 100%，而年龄较大的儿童为 86.4%（P=1.0）。然而，3 至 6 个月大的儿童通气时间更长（P=0.01）、重症监护停留时间更长（P=0.03）和住院时间更长（P=0.05）。同时行共同房室瓣修复术的患者，20 年时无死亡或移植的生存率为 33%，而未行共同房室瓣修复术的患者为 79%（P=0.02）。
川岛手术具有低手术风险和可接受的长期结果。对年龄小于 6 个月的患者行川岛手术不会影响生存率，但与发病率增加有关。需要行共同房室瓣手术的患者具有显著的死亡风险，需要更有效的房室瓣修复技术。
