18 Years of the Fontan Operation at a Single Institution Results From 771 Consecutive Patients

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Rogers, Lindsay S.^1,2  Glatz, Andrew C.^1,2  Ravishankar, Chitra^1,2  Spray, Thomas L.^1,3  Nicolson, Susan C.^1,4  Rychik, Jack^1,2  Rush, Christina Hayden¹  Gaynor, J. William^1,3  Goldberg, David J.^1,2 

[1] Childrens Hosp Philadelphia, Cardiac Ctr, Philadelphia, PA 19104 USA

[2] Univ Penn, Div Pediat Cardiol, Perelman Sch Med, Philadelphia, PA 19104 USA

[3] Univ Penn, Dept Surg, Perelman Sch Med, Philadelphia, PA 19104 USA

[4] Univ Penn, Dept Anesthesiol & Crit Care, Perelman Sch Med, Philadelphia, PA 19104 USA

关键词: cardiopulmonary bypass;    congenital heart defects;    Fontan procedure;    single ventricle;   

DOI  :  10.1016/j.jacc.2012.05.010

来源: Elsevier

【 摘 要 】

Objectives The aim of this study was to evaluate Fontan peri-operative outcomes for 771 consecutive patients. Background Since the initial description by Fontan, mortality associated with the Fontan operation has declined substantially. However, postoperative effusions remain a significant challenge. Effusions are a key determinant of postoperative length-of-stay and have been shown to be associated with the development of protein-losing enteropathy and with decreased survival. Methods This study was a single-center, retrospective review of 771 patients who underwent Fontan palliation from 1992 to 2009. Results Patients were divided into 3 eras dictated by shift in clinical practice. Overall mortality was 3.5%, 1% since 1996. Importantly, age at Stage II palliation decreased from Era 1 to Era 3 (7.1 vs. 5.9 months; p = 0.0001), whereas age at Fontan increased (1.7 vs. 2.8 years; p = 0.0001). The proportion of patients with prolonged hospital stay (46.7% vs. 8.2% vs. 19.5%, p < 0.001) decreased substantially after Era 1. A diagnosis of hypoplastic left heart syndrome and longer operative support times were associated with prolonged pleural drainage (odds ratio [OR]: 2.17, p < 0.001; OR: 1.2, p = 0.001) and hospital stay (OR: 1.48, p = 0.05; OR: 1.34, p < 0.001). In patients who underwent invasive assessment, higher pulmonary artery pressure was associated with death (OR: 1.37, p = 0.001) and prolonged hospital stay (OR: 1.09, p = 0.019). Pulmonary arterial pressure >= 15 mm Hg was 90% specific for discriminating unfavorable outcomes. Conclusions Mortality in the modern era is rare, whereas postoperative pleural drainage remains the dominant morbidity. Elevated pulmonary artery pressure seems to be a marker of unfavorable outcome. Continued investigation is warranted to determine whether medical interventions or alterations to operative strategy can alter perioperative results and improve long-term outcomes. (J Am Coll Cardiol 2012;60:1018-25) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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