Abstract

 

OBJECTIVES

Patients who have achieved Fontan circulation may require reoperation. We reviewed the outcomes of reoperation after Fontan completion and assessed the risk factors for poor outcomes.

METHODS

This was a retrospective study of 106 patients undergoing open-heart reoperations after Fontan completion in 2003 at a single institution.

RESULTS

The mean age at reoperation was 24.6 ± 8.3 years. A history of Fontan failure or end-organ dysfunction was noted in 30 patients. The reoperations included 73 total cavopulmonary connection conversions, 29 atrioventricular or semilunar valve operations (17 with total cavopulmonary connection conversions) and 4 other operations. Eight early deaths occurred. During a median follow-up of 5.5 (0.01–16.2) years, there were 3 late deaths and 9 second cardiac operations. The 10-year survival rate after reoperation was 89.8%, and the 5-year second cardiac operation-free survival was 84.3%. The 10-year survival rates were significantly lower in patients who underwent surgery before 2011 (75.8% vs 100%), had a history of Fontan failure or end-organ dysfunction (71.7% vs 97.3%), had preoperative central venous pressure >15 mmHg (64.9% vs 96.5%) and were operated on with deep hypothermic circulatory arrest (DHCA) (60.0% vs 91.3%). A history of Fontan failure or end-organ dysfunction, preoperative central venous pressure >15 mmHg and requirement of DHCA were identified as risk factors for mortality.

CONCLUSIONS

Reoperation after Fontan completion resulted in excellent mid-term outcomes. A history of failed Fontan circulation and the requirement of DHCA negatively affected survival outcomes.

中文翻译：

---

Fontan完成后再次手术的手术结果

摘要

 

目标

达到 Fontan 循环的患者可能需要再次手术。我们回顾了 Fontan 完成后再次手术的结果，并评估了不良结果的危险因素。

方法

这是一项回顾性研究，对 2003 年 Fontan 完成后在单一机构接受心脏直视再手术的 106 名患者进行了研究。

结果

再次手术的平均年龄为 24.6 ± 8.3 岁。30 名患者有 Fontan 衰竭或终末器官功能障碍病史。再手术包括 73 例腔肺连接转换、29 例房室或半月瓣手术（17 例为完全腔肺连接转换）和 4 例其他手术。发生八人早期死亡。在 5.5（0.01-16.2）年的中位随访期间，有 3 例晚期死亡和 9 次心脏手术。再次手术后10年生存率为89.8%，第2次心脏手术后5年生存率为84.3%。2011 年之前接受手术的患者（75.8% 对 100%）、有 Fontan 衰竭或终末器官功能障碍病史（71.7% 对 97.3%）、术前中心静脉压 >15 的患者 10 年生存率显着降低毫米汞柱（64.9% 对 96. 5%）并在深低温停循环（DHCA）下进行手术（60.0% 对 91.3%）。Fontan 衰竭或终末器官功能障碍病史、术前中心静脉压 >15 mmHg 和需要 DHCA 被确定为死亡的危险因素。

结论

Fontan 完成后的再次手术产生了出色的中期结果。Fontan 循环失败的历史和 DHCA 的要求对生存结果产生负面影响。