Grozdanov Dimitrij, Matsubara Muneaki, Osawa Takuya, Palm Jonas, Schaeffer Thibault, Niedermaier Carolin, Piber Nicole, Heinisch Paul P, Georgiev Stanimir, Hager Alfred, Ewert Peter, Hörer Jürgen, Ono Masamichi
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany.
Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6). doi: 10.1093/icvts/ivaf118.
In this study, we aimed to compare the outcome after the Fontan procedure in patients after an initial ductus stenting or a surgical aortopulmonary shunt.
We reviewed infants with single ventricle and ductal-dependent pulmonary blood flow who underwent ductus stenting or an aortopulmonary shunt between 2009 and 2022, and subsequently underwent the staged Fontan procedure.
A total of 93 patients were included (39 ductus stenting and 54 aortopulmonary shunts). Before the Fontan procedure, pulmonary artery pressure (9 vs 9 mmHg, P = 0.376) and pulmonary artery index (184 vs 183 mm2/m2, P = 0.988) were similar between the groups. However, the incidence of venovenous collaterals was higher in patients after ductus stenting than those after aortopulmonary shunt (35.9 vs 16.7%, P = 0.034). Median age (1.9 vs 1.8 years, P = 0.493) and weight at the Fontan procedure (12 vs 11 kg, P = 0.596) were similar between the groups. There was no in-hospital mortality in each group. The length of the intensive care unit stay (median 5 vs 5 days, P = 0.542) and hospital stay (median 17 vs 14 days, P = 0.767) were similar between the groups. During the median follow-up of 2.5 years, one late death was observed in the ductal stenting group. Freedom from reintervention (66.6 vs 82.0%, P = 0.095) and from adverse events (78.6 vs 92.2%, P = 0.488) at 5 years were similar between the groups.
This pilot study demonstrated comparable outcomes following the Fontan procedures between patients with single ventricle and ductal-dependent pulmonary blood flow after initial ductus stenting and those after initial aortopulmonary shunt.
在本研究中，我们旨在比较初次动脉导管支架置入术或外科主动脉-肺动脉分流术后接受Fontan手术患者的结局。
我们回顾了2009年至2022年间接受动脉导管支架置入术或主动脉-肺动脉分流术，随后接受分期Fontan手术的单心室且依赖动脉导管供血的肺血流婴儿。
共纳入93例患者（39例行动脉导管支架置入术，54例行主动脉-肺动脉分流术）。在Fontan手术前，两组间肺动脉压（9 vs 9 mmHg，P = 0.376）和肺动脉指数（184 vs 183 mm²/m²，P = 0.988）相似。然而，动脉导管支架置入术后患者的腔静脉侧支发生率高于主动脉-肺动脉分流术后患者（35.9% vs 16.7%，P = 0.034）。两组间Fontan手术时的中位年龄（1.9 vs 1.8岁，P = 0.493）和体重（12 vs 11 kg，P = 0.596）相似。每组均无院内死亡。两组间重症监护病房住院时间（中位5 vs 5天，P = 0.542）和住院时间（中位17 vs 14天，P = 0.767）相似。在中位随访2.5年期间，动脉导管支架置入术组观察到1例晚期死亡。两组间5年时免于再次干预（66.6% vs 82.0%，P = 0.095）和免于不良事件（78.6% vs 92.2%，P = 0.488）的情况相似。
这项初步研究表明，单心室且依赖动脉导管供血的肺血流患者在初次动脉导管支架置入术后和初次主动脉-肺动脉分流术后接受Fontan手术的结局具有可比性。
