초록접수 현황
| 15F-049 | 구연 발표 |
Long-term Outcome of Fontan Operation
박지영¹, 손봉연¹, 서동현¹, 정준철¹, 김지성¹, 임홍국¹, 현관용¹, 조성규¹, 김웅한¹, 이정렬¹, 김용진²
서울대학교 의과대학 서울대학교병원 흉부외과학교실¹, 서울대학교 의과대학 분당서울대학교병원 흉부외과학교실²
Background : This study is undertaken retrospectively to review the clinical results and effectiveness of atriopulmonary fontan (AP), lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution.
Methods : Between June 1986 and December 2014, 466 patients underwent various Fontan procedure our institution and medical record was available for 434 patients (AP: 112, LT: 140, ECC: 182). The survival rate, the incidence and the risk factor of late complications were evaluated retrospectively.
Results : There were 45 early death (< 30 days or hospital death ), 26 in AP group, 13 in LT group and 6 in ECC group. The mean follow-up in the AP, LT and ECC groups was 19.0±9.4, 17.5±4.8 and 7.9±4.6 years, respectively. Threre were 21 late deaths, 13 patinets in AP group. Kaplan-Meier estimated survival was 93.7 %, 98.3 % and 98.0 % at 10 years, 85.8 %, 94.8 % and 98.0 % at 15 years, respectively (p=0.06). The surviving patients showed NYHA functional class I in 85 %, class II in 13 %. Freedom from reoperation in each group was 80 %, 75.8 % and 83.5 % at 15 years (p= 0.71). Fontan conversion were necessary in 9.4 % of patients at average 17.7±5.7 years after initial Fontan operation. In arrhythmia, the ECC patients showed a slightly low incidence but the difference was not statistically significant. Fontan related liver problem including liver cirrhosis was reported in 38 patients and protein losing enteropathy in 17 patients.
Conclusion : This study revealed that the recent survival rate of Fontan type operation was satisfactory, but the occurrence of late complications after a Fontan type operation increased with the longer survival. There is a need for strict follow up and early treatment of late complications in patients who had a Fontan operation.
Methods : Between June 1986 and December 2014, 466 patients underwent various Fontan procedure our institution and medical record was available for 434 patients (AP: 112, LT: 140, ECC: 182). The survival rate, the incidence and the risk factor of late complications were evaluated retrospectively.
Results : There were 45 early death (< 30 days or hospital death ), 26 in AP group, 13 in LT group and 6 in ECC group. The mean follow-up in the AP, LT and ECC groups was 19.0±9.4, 17.5±4.8 and 7.9±4.6 years, respectively. Threre were 21 late deaths, 13 patinets in AP group. Kaplan-Meier estimated survival was 93.7 %, 98.3 % and 98.0 % at 10 years, 85.8 %, 94.8 % and 98.0 % at 15 years, respectively (p=0.06). The surviving patients showed NYHA functional class I in 85 %, class II in 13 %. Freedom from reoperation in each group was 80 %, 75.8 % and 83.5 % at 15 years (p= 0.71). Fontan conversion were necessary in 9.4 % of patients at average 17.7±5.7 years after initial Fontan operation. In arrhythmia, the ECC patients showed a slightly low incidence but the difference was not statistically significant. Fontan related liver problem including liver cirrhosis was reported in 38 patients and protein losing enteropathy in 17 patients.
Conclusion : This study revealed that the recent survival rate of Fontan type operation was satisfactory, but the occurrence of late complications after a Fontan type operation increased with the longer survival. There is a need for strict follow up and early treatment of late complications in patients who had a Fontan operation.
책임저자: 김용진
서울대학교 의과대학 분당서울대학교병원 흉부외과학교실
연락처 : 김용진, Tel: 010-7765-8731 , E-mail : kyj@plaza.snu.ac.kr
