Division of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand.
Asian Cardiovasc Thorac Ann. 2024 Nov;32(8-9):451-461. doi: 10.1177/02184923241292688. Epub 2024 Oct 23.
Fenestrated total cavopulmonary connection has gained popularity due to its capacity to reduce systemic venous pressure and enhance cardiac output. However, there is ongoing debate about the immediate and long-term advantages of fenestration in this context.
A retrospective cohort study was conducted involving 97 patients who underwent extracardiac total cavopulmonary connection at Chiang Mai University Hospital between January 1999 and December 2019. The patients were initially categorized into two groups: fenestrated ( = 71) and nonfenestrated ( = 26). After exclusion and reassignment, the long-term outcomes were analyzed for the fenestrated ( = 68) and nonfenestrated ( = 25) groups. To address potential confounding factors between the two groups, propensity scores were computed using logistic regression analysis.
The study found no significant differences in preoperative and operative data. Immediate postoperative outcomes showed no significant variations in major complications, intensive care unit stay, oxygen saturation, and posttotal cavopulmonary connection pressure. In the long-term assessment, the fenestrated group demonstrated significantly lower rates of mortality, protein-losing enteropathy, liver mass, and cirrhosis. However, after employing a multilevel model stratified by propensity score analysis, only long-term mortality rate was significantly lower in the fenestrated group (hazard ratio = 0.12, 95% confidence interval = 0.02-0.97). Fenestration patency closed gradually through spontaneous closure and device intervention.
The study found no major differences in immediate postoperative outcomes. In the fenestrated cohort, significantly lower incidences of protein-losing enteropathy, liver mass, cirrhosis, and long-term mortality were observed. However, multilevel model stratified by propensity score analysis indicated that only the lower long-term mortality demonstrated a major effect.
由于 fenestrated total cavopulmonary connection 能够降低体循环静脉压并提高心输出量，因此它越来越受欢迎。然而，在这种情况下 fenestration 的即时和长期优势仍存在争议。
本研究回顾性分析了 1999 年 1 月至 2019 年 12 月在清迈大学医院接受体外 total cavopulmonary connection 的 97 例患者。这些患者最初分为 fenestrated 组（n=71）和 nonfenestrated 组（n=26）。排除和重新分组后，对 fenestrated 组（n=68）和 nonfenestrated 组（n=25）进行了长期结局分析。为了消除两组之间的潜在混杂因素，采用逻辑回归分析计算倾向评分。
研究发现两组患者的术前和手术数据无显著差异。术后即刻结果显示，两组在主要并发症、重症监护病房停留时间、氧饱和度和 posttotal cavopulmonary connection 压力方面无显著差异。在长期评估中，fenestrated 组的死亡率、蛋白丢失性肠病、肝肿大和肝硬化发生率显著较低。然而，采用倾向评分分析分层的多水平模型后，仅 fenestrated 组的长期死亡率显著降低（风险比=0.12，95%置信区间=0.02-0.97）。fenestration 管腔逐渐通过自发性闭合和器械干预而关闭。
本研究发现两组患者的术后即刻结局无显著差异。在 fenestrated 组，观察到蛋白丢失性肠病、肝肿大、肝硬化和长期死亡率的发生率显著较低。然而，倾向评分分析分层的多水平模型表明，只有较低的长期死亡率具有显著影响。
