초록접수 현황
| 16F-279 | 구연 발표 |
The Influence of Postoperative Outcome after the Fenestration of an Extracardiac Conduit Fontan in the High-risk Patients
Ji Hyun Bang, Eung Rae Kim, Jae Gun Kwak, Woong-Han Kim, Jeong Ryul Lee, Yong Jin Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
Background : This study sought to compare long-term outcomes after fenestrated and non-fenestrated Fontan palliation.
Methods : Fenestration was performed selectively in 18 patients (19.4%) whereas 70 patients (80.6%) was not performed fenestration with Fontan operation between January 2004 and May 2016. Outcomes were compared by hospital stay, chest drain duration, short- and long-term survivals, and late interventions.
Results : Anatomic subtypes were single left ventricle (n = 39, 44.3%), single right ventricle (n = 43, 48.9%), common ventricle (n = 6, 6.8%), and heterotaxy syndrome (n = 19, 21.5%). Mean age and weight at surgery were 5.8 ± 16.9 years and 14.7 ± 6.4 kg, respectively. Fenestration group had higher preoperative pulmonary arterial pressure (12.3 ± 2.4 vs. 10.8 ± 2.9, P=0.04), higher preoperative pulmonary vascular resistance (1.9 ± 1.1 vs. 1.5 ± 0.6, P=0.03) than non-fenestrated group. Median arterial oxygen saturations at discharge were 88% in fenestrated and 96% in non-fenestrated patients (p < 0.001). Fenestrated group has higher Fontan pressure than non-fenestrated group (18.6 ± 2.2 vs. 16.3 ± 2.2, P< 0.001). Prolonged (>2 weeks) pleural drainage occurred in 51 patients, 10 (55.5%) with fenestration and 41 (58.5%) without fenestration (P>0.05). Mean hospital stay was 26.9 ± 13.1 days and mean ICU stay was 3.7 ± 3.3 days and there was no intergroup differences. During follow-up of 6.9 ± 3.5 years, there was no late death and 3 patients developed protein losing enteropathy (1 in the fenestrated group), without intergroup differences. Fontan take-down occurred in 1 patients in non-fenestrated group. Neurologic complications including stroke, seizure were developed in 7 patients (4 in the fenestrated group, P=0.03).
Conclusion : Highly selective use of Fontan fenestration is achievable while maintaining favorable outcomes without increased surgical morbidity or mortality, irrespective of anatomic subtype. However, Fontan fenestration has risks of postoperative hypoxia and neurologic complications
Methods : Fenestration was performed selectively in 18 patients (19.4%) whereas 70 patients (80.6%) was not performed fenestration with Fontan operation between January 2004 and May 2016. Outcomes were compared by hospital stay, chest drain duration, short- and long-term survivals, and late interventions.
Results : Anatomic subtypes were single left ventricle (n = 39, 44.3%), single right ventricle (n = 43, 48.9%), common ventricle (n = 6, 6.8%), and heterotaxy syndrome (n = 19, 21.5%). Mean age and weight at surgery were 5.8 ± 16.9 years and 14.7 ± 6.4 kg, respectively. Fenestration group had higher preoperative pulmonary arterial pressure (12.3 ± 2.4 vs. 10.8 ± 2.9, P=0.04), higher preoperative pulmonary vascular resistance (1.9 ± 1.1 vs. 1.5 ± 0.6, P=0.03) than non-fenestrated group. Median arterial oxygen saturations at discharge were 88% in fenestrated and 96% in non-fenestrated patients (p < 0.001). Fenestrated group has higher Fontan pressure than non-fenestrated group (18.6 ± 2.2 vs. 16.3 ± 2.2, P< 0.001). Prolonged (>2 weeks) pleural drainage occurred in 51 patients, 10 (55.5%) with fenestration and 41 (58.5%) without fenestration (P>0.05). Mean hospital stay was 26.9 ± 13.1 days and mean ICU stay was 3.7 ± 3.3 days and there was no intergroup differences. During follow-up of 6.9 ± 3.5 years, there was no late death and 3 patients developed protein losing enteropathy (1 in the fenestrated group), without intergroup differences. Fontan take-down occurred in 1 patients in non-fenestrated group. Neurologic complications including stroke, seizure were developed in 7 patients (4 in the fenestrated group, P=0.03).
Conclusion : Highly selective use of Fontan fenestration is achievable while maintaining favorable outcomes without increased surgical morbidity or mortality, irrespective of anatomic subtype. However, Fontan fenestration has risks of postoperative hypoxia and neurologic complications
책임저자: Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
발표자: Ji Hyun Bang, E-mail : mibbi@naver.com