Ko Hoon, Song Jinyoung, Chi Sang Ah, Lee Sang-Yun, Kim Soo-Jin, Lee Chang-Ha, Park Chun Soo, Choi Eun Seok, An Hyo Soon, Kang I Seok, Yoon Ja Kyoung, Baek Jae-Suk, Lee Jae-Young, Lee Joowon, Huh June, Ahn Kyung-Jin, Jung Se Yong, Cha Seul Gi, Kim Yeo-Hyang, Lee Young-Seok
Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Front Cardiovasc Med. 2024 May 7;11:1341882. doi: 10.3389/fcvm.2024.1341882. eCollection 2024.
The long-term effects of fenestration in patients with Fontan circulation remain unclear. We aim to evaluate the fenestration impact on early and late outcomes in patients with extracardiac Fontan (ECF) using a propensity score matching analysis.
We performed an extensive retrospective multicenter clinical data review of the Korean Fontan registry and included 1,233 patients with surgical ECF (779 fenestrated, 454 non-fenestrated). Demographics, baseline, and follow-up data were collected and comprehensively analyzed. Patients were divided into two groups according to the baseline presence or absence of surgical fenestration. Subsequently, patients were sub-divided according to the fenestration status at the last follow-up. Propensity-score matching was performed to account for collected data between the 2 groups using a multistep approach. The primary outcomes were survival and freedom from Fontan failure (FFF). We also looked at postoperative hemodynamics, cardiopulmonary exercise test results, oxygen saturations, and functional status.
After propensity-score matching (454 matched pairs), there was no difference in survival or FFF between the 2 groups. However, ECF patients with baseline fenestration had significantly lower oxygen saturation (= 0.001) and lower functional status (< 0.001). Patients with fenestration had significantly longer bypass times, higher postoperative central venous pressure, higher postoperative left atrial pressure, and less prolonged pleural effusion in the early postoperative period. The propensity score matching according to the fenestration status at the last follow-up (148 matched pairs) showed that patients with a persistent fenestration had significantly lower oxygen saturation levels (< 0.001). However there were no intergroup differences in the functional status, survival and FFF.
Our results showed no long-term benefits of the Fenestration in terms of survival and FFF. Patients with persistent fenestration showed oxygen desaturation but no difference in exercise intolerance was shown between the 2 groups.
Fontan循环患者开窗术的长期影响尚不清楚。我们旨在通过倾向评分匹配分析评估开窗术对心外膜Fontan（ECF）患者早期和晚期结局的影响。
我们对韩国Fontan注册中心进行了广泛的回顾性多中心临床数据审查，纳入1233例行外科ECF手术的患者（779例有开窗术，454例无开窗术）。收集并综合分析人口统计学、基线和随访数据。根据基线时是否存在外科开窗术将患者分为两组。随后，根据最后一次随访时的开窗状态将患者进一步细分。采用多步骤方法进行倾向评分匹配，以处理两组之间收集的数据。主要结局为生存率和无Fontan衰竭（FFF）。我们还观察了术后血流动力学、心肺运动试验结果、血氧饱和度和功能状态。
经过倾向评分匹配（454对匹配）后，两组在生存率或FFF方面无差异。然而，基线时有开窗术的ECF患者血氧饱和度显著较低（=0.001），功能状态较差（<0.001）。有开窗术的患者术后体外循环时间明显更长，术后中心静脉压更高，术后左心房压更高，术后早期胸腔积液持续时间更短。根据最后一次随访时的开窗状态进行倾向评分匹配（148对匹配）显示，持续开窗的患者血氧饱和度水平显著较低（<0.001）。然而，两组在功能状态、生存率和FFF方面无组间差异。
我们的结果显示，开窗术在生存率和FFF方面没有长期益处。持续开窗的患者出现氧饱和度降低，但两组在运动不耐受方面没有差异。
