心房肺动脉吻合术改良与全腔静脉肺动脉吻合术改良的Fontan手术对比评估

Comparative assessment of Fontan operation in modifications of atriopulmonary and total cavopulmonary anastomoses.

作者信息

Podzolkov V P, Zaets S B, Chiaureli M R, Alekyan B G, Zotova L M, Chernikh I G

机构信息

Scientific Centre of Cardiovascular Surgery RAMS, Moscow, Russia.

出版信息

Eur J Cardiothorac Surg. 1997 Mar;11(3):458-65. doi: 10.1016/s1010-7940(96)01108-6.

DOI:10.1016/s1010-7940(96)01108-6

PMID:9105809

Abstract

OBJECTIVES

The optimal technique of the Fontan operation remains disputable. This investigation was aimed at the comparison of atriopulmonary and total cavopulmonary anastomoses.

METHODS

The results of 81 operations of total cavopulmonary and 69 operations of atriopulmonary anastomosis, performed from 1983 to 1995 were analysed. A control study was carried out 1-10 (3.7 + 0.2) years after the operation in 80 patients (36 after total cavopulmonary and 44 after atriopulmonary anastomoses). 70 patients were studied several times. Cardiac catheterization was done in 70 patients. In 78 patients central hemodynamical indices were studied during exercise.

RESULTS

Preoperative hemodynamical indices were not reliably different in the two groups. Early mortality after total cavopulmonary anastomosis was 15%, after atriopulmonary anastomosis 23%. The highest mortality was seen when the criteria of Choussat et al. (Choussat et al. Pediatric Cardiology. Edinburgh: 1977:559-566) were surpassed. In the early postoperative period after total cavopulmonary anastomosis circulatory insufficiency was less marked, transsudation from pleural cavities was reliably lower (15.3 + 1.2 versus 25.5 + 1.8 ml/kg/day, P < 0.01). Arrhythmias were more common after total cavopulmonary anastomosis (18.5 versus 12%). Late mortality after total cavopulmonary anastomosis was 6%, after atriopulmonary anastomosis 12%. 82% of patients after atriopulmonary anastomosis and 81% after total cavopulmonary anastomosis were in NYHA classes 1 and 2.7% of patients after total cavopulmonary anastomosis and 11% after atriopulmonary anastomosis were reoperated. Physical tolerance rose stepwise in both groups and by the third post-operative year reached 75% of normal level. At this time we saw the most optimal hemodynamical indices during exercise. However, the best hemodynamics during exercise were seen after atriopulmonary anastomosis.

CONCLUSIONS

Total cavopulmonary anastomosis is accompanied by lower mortality rate and a more favourable course of early postoperative period. However, the best long-term functional results are obtained after atriopulmonary anastomosis.

摘要

目的

Fontan手术的最佳技术仍存在争议。本研究旨在比较心房肺动脉吻合术和全腔静脉肺动脉吻合术。

方法

分析了1983年至1995年期间进行的81例全腔静脉肺动脉吻合术和69例心房肺动脉吻合术的结果。对80例患者（全腔静脉肺动脉吻合术后36例，心房肺动脉吻合术后44例）在术后1 - 10（3.7±0.2）年进行了对照研究。70例患者接受了多次研究。70例患者进行了心导管检查。78例患者在运动期间研究了中心血流动力学指标。

结果

两组术前血流动力学指标无显著差异。全腔静脉肺动脉吻合术后早期死亡率为15%，心房肺动脉吻合术后为23%。当超过Choussat等人（Choussat等人，《小儿心脏病学》，爱丁堡：1977：559 - 566）的标准时，死亡率最高。全腔静脉肺动脉吻合术后早期，循环功能不全不太明显，胸腔渗出液明显较少（15.3±1.2对25.5±1.8 ml/kg/天，P<0.01）。全腔静脉肺动脉吻合术后心律失常更常见（18.5%对12%）。全腔静脉肺动脉吻合术后晚期死亡率为6%，心房肺动脉吻合术后为12%。心房肺动脉吻合术后82%的患者和全腔静脉肺动脉吻合术后81%的患者心功能分级为纽约心脏协会（NYHA）I级和II级。全腔静脉肺动脉吻合术后7%的患者和心房肺动脉吻合术后11%的患者接受了再次手术。两组患者的身体耐受力逐步提高，术后第三年达到正常水平的75%。此时，我们在运动期间观察到了最理想的血流动力学指标。然而，运动期间最佳的血流动力学表现见于心房肺动脉吻合术后。