Gentles T L, Gauvreau K, Mayer J E, Fishberger S B, Burnett J, Colan S D, Newburger J W, Wernovsky G
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
J Thorac Cardiovasc Surg. 1997 Sep;114(3):392-403; discussion 404-5. doi: 10.1016/s0022-5223(97)70184-3.
The purpose of this study was to describe the functional outcome of a large number of patients after modifications of the Fontan operation and to investigate perioperative risk factors that might influence late functional state.
A comprehensive cross-sectional review of the first 500 patients undergoing a Fontan operation at our institution was undertaken. Those surviving with an intact Fontan circulation were reviewed by questionnaire to assess functional status and medication history. Medical records, chest roentgenograms, echocardiograms, cardiac catheterizations, and laboratory investigations were also reviewed to assess postoperative status.
Three hundred sixty-three long-term survivors with an intact Fontan circulation were identified during cross-sectional follow-up. Median age at operation was 5.0 years (range 0.4 to 31 years), and median follow-up was 5.4 years (range 1.7 to 20 years). Most patients (91.1%) were in New York Heart Association class I or II. In a multivariate model, poor (class III or IV) functional state was associated with longer duration of follow-up (p < 0.001), a prior atrial septectomy (p = 0.03), and a prior main pulmonary artery-ascending aorta anastomosis (p = 0.05).
A poor functional outcome is uncommon after the Fontan operation but becomes more frequent with increasing duration of follow-up.
本研究的目的是描述大量接受改良Fontan手术患者的功能结局，并调查可能影响晚期功能状态的围手术期危险因素。
对在我们机构接受Fontan手术的前500例患者进行了全面的横断面回顾。通过问卷调查对Fontan循环完整存活的患者进行评估，以评估其功能状态和用药史。还回顾了病历、胸部X光片、超声心动图、心导管检查和实验室检查，以评估术后状态。
在横断面随访期间，确定了363例Fontan循环完整的长期存活者。手术时的中位年龄为5.0岁（范围0.4至31岁），中位随访时间为5.4年（范围1.7至20年）。大多数患者（91.1%）属于纽约心脏协会I级或II级。在多变量模型中，功能状态差（III级或IV级）与随访时间延长（p < 0.001）、既往房间隔切除术（p = 0.03）和既往主肺动脉-升主动脉吻合术（p = 0.05）相关。
Fontan手术后功能结局差并不常见，但随着随访时间的延长而变得更为频繁。
