Cleveland D C, Kirklin J K, Naftel D C, Kirklin J W, Blackstone E H, Pacifico A D, Bargeron L M
Ann Thorac Surg. 1984 Nov;38(5):447-57. doi: 10.1016/s0003-4975(10)64183-5.
Despite increasing experience with the surgical treatment of tricuspid atresia, controversy exists regarding the early and late results of the various surgical options. Between January 1, 1967, and September 1, 1982, 92 patients underwent 147 operations for tricuspid atresia. Eighty-five patients underwent 1 or more palliative operations (108 procedures), with 8 hospital deaths (9%; confidence limits [CL], 6 to 14%). Thirty-eight patients underwent 44 classic (Blalock-Taussig or Gore-Tex) shunts, with 3 early (7%; CL, 3 to 13%) and 3 late deaths. Actuarial survival at 5 years was 78%, but only 56% were alive and free from having to undergo further operation at 5 years. Thirty-seven patients underwent a Fontan procedure, with 5 hospital deaths (14%; CL, 8 to 22%). Of these 37 patients, 34 (92%) had a nonvalved connection between the right atrium and the right ventricular infundibulum or the pulmonary artery. Incremental risk factors for hospital mortality after the Fontan procedure in patients with tricuspid atresia as well as other cardiac anomalies include young age (p = 0.0003), diagnosis other than tricuspid atresia (p = 0.03), and complex associated procedures (p = 0.02). During the year 1983, hospital mortality was 7% (1 out of 14; CL, 1 to 22%) for the Fontan procedure without complex additional procedures. Actuarial survival after a Fontan procedure was 71% at 5 years, with 3 patients requiring late reoperation. Of the survivors, 96% are in New York Heart Association Functional Class I or II. The Fontan procedure without a valve offers good intermediate survival, good functional results, and few reoperations. In patients with diminished pulmonary blood flow, a classic shunt also provides good palliation and good intermediate survival, but there is a necessity for additional operations in many patients within 5 years.
尽管三尖瓣闭锁外科治疗的经验不断增加，但对于各种手术方式的早期和晚期结果仍存在争议。在1967年1月1日至1982年9月1日期间，92例患者接受了147次三尖瓣闭锁手术。85例患者接受了1次或更多次姑息性手术（108例手术），8例住院死亡（9%；置信区间[CL]，6%至14%）。38例患者接受了44次经典（Blalock-Taussig或Gore-Tex）分流术，3例早期死亡（7%；CL，3%至13%），3例晚期死亡。5年的精算生存率为78%，但5年后只有56%的患者存活且无需再次手术。37例患者接受了Fontan手术，5例住院死亡（14%；CL，8%至22%）。在这37例患者中，34例（92%）在右心房与右心室漏斗部或肺动脉之间建立了无瓣膜连接。三尖瓣闭锁及其他心脏异常患者接受Fontan手术后住院死亡率的增加危险因素包括年轻（p = 0.0003）、非三尖瓣闭锁诊断（p = 0.03）和复杂的相关手术（p = 0.02）。1983年，无复杂附加手术的Fontan手术住院死亡率为7%（14例中的1例；CL，1%至22%）。Fontan手术后5年的精算生存率为71%，3例患者需要晚期再次手术。在幸存者中，96%的心功能分级为纽约心脏协会I级或II级。无瓣膜的Fontan手术提供了良好的中期生存率、良好的功能结果且再次手术较少。在肺血流量减少的患者中，经典分流术也能提供良好的姑息治疗和中期生存率，但许多患者在5年内需要再次手术。
