Molloy Ashley, Tailor Neil, Hunter Katherine, Boston Umar, Sathanandam Shiva, Sathanandam Shyam
Division of Pediatric Cardiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, 848 Adams Avenue, Memphis, TN, 38103, USA.
Heart Center, Division of Cardiac Surgery, Children's Hospital of the King's Daughters, Norfolk, VA, USA.
Pediatr Cardiol. 2025 Jul 15. doi: 10.1007/s00246-025-03946-x.
This study investigates the benefits of coiling aortopulmonary collaterals (APCs) before Fontan completion and prior to heart transplantation due to failed Fontan. The advantages of APC coiling in these situations remain unclear. Outcomes were compared between those undergoing the Fontan operation between June 2013 and December 2015, who did not undergo coiling of APCs, and those between January 2016 and May 2022, when aggressive coiling of APCs was performed. The 1-year post-transplant survival was compared for patients from Memphis, TN, where aggressive APC coiling was performed before transplantation, to a previously published report from St. Louis, MO, where APCs were actively coiled and an earlier era when they were not. The 44 Fontan patients with prior APC coiling were compared to 22 patients matched for age, diagnosis, and hemodynamics. The chest tube output (22.6 ± 6.1 vs. 41.8 ± 8.2 mL/kg; P < 0.001), the chest tube duration (5.1 ± 1.1 vs. 10.3 ± 4.5 days; P < 0.001), and the hospital length of stay (9.9 ± 1.7 vs. 27.4 ± 6.2 days; P < 0.001) were significantly lower for those who had APC coiling compared to those who did not. In St. Louis, MO, when APCs were not coiled before transplantation (N = 27), the 1-year survival rate was 66%, which improved to 85% (N = 20) in the era of APC coiling. In the Memphis experience (N = 25) with aggressive APC coiling, the 1-year survival rate was 92% (P = 0.018). APC coiling before Fontan completion decreases chest tube output and hospitalization days. It may also improve the 1-year survival rate after heart transplantation for children with failed Fontan.
本研究调查了在Fontan手术完成前以及因Fontan手术失败而进行心脏移植前对主肺动脉侧支（APC）进行栓塞的益处。在这些情况下APC栓塞的优势仍不明确。对2013年6月至2015年12月期间接受Fontan手术且未进行APC栓塞的患者，与2016年1月至2022年5月期间积极进行APC栓塞的患者的结局进行了比较。将田纳西州孟菲斯市在移植前积极进行APC栓塞的患者的1年移植后生存率，与先前发表的来自密苏里州圣路易斯市的报告（其中APC被积极栓塞）以及更早时期（未进行APC栓塞）的情况进行了比较。将44例先前进行过APC栓塞的Fontan患者与22例在年龄、诊断和血流动力学方面相匹配的患者进行了比较。与未进行APC栓塞的患者相比，进行APC栓塞的患者的胸管引流量（22.6±6.1 vs. 41.8±8.2 mL/kg；P<0.001）、胸管留置时间（5.1±1.1 vs. 10.3±4.5天；P<0.001）以及住院时间（9.9±1.7 vs. 27.4±6.2天；P<0.001）均显著更低。在密苏里州圣路易斯市，移植前未进行APC栓塞时（N = 27），1年生存率为66%，在APC栓塞时代提高到了85%（N = 20）。在孟菲斯市积极进行APC栓塞的经验中（N = 25），1年生存率为92%（P = 0.018）。在Fontan手术完成前进行APC栓塞可减少胸管引流量和住院天数。它还可能提高Fontan手术失败的儿童心脏移植后的1年生存率。
