背景:在心内膜垫缺损(ECD)患者中,Fontan手术(FO)的传统结果并不理想。以前的研究受到ECD患者数量较少的限制,更长的学习时间,具有时代效应,并且不直接比较FO在ECD患者与非ECD患者中的短期结局。我们的研究旨在解决这些缺点。
方法:对FO的儿童住院患者数据库(2009年、2012年和2016年)进行了回顾性分析。与非ECD诊断相比,这些组被分为接受ECD的FO组。数据是根据人口统计学提取的,临床特征,和手术结果。使用标准统计检验。
结果:三千三百八十例患者接受了FO,其中360例(11%)为FO-ECD。ECD患者更有可能患有唐氏综合征,异位综合征,转座/DORV,和TAPVR与非ECD患者相比。FO-ECD的出院死亡率较高(2.84%vs.0.45%,p=.04)。停留时间(16vs.13天,p=0.05)和产生的总费用(283美元,280美元与与非ECD患者相比,FO-ECD患者的入院费用为$234,106,p=.03)更高。在多变量分析中,ECD诊断,心脏骤停,急性肾损伤,术后出血是死亡率的预测因素。
结论:FO的当代结局非常好,总手术死亡率非常低。然而,ECD患者的结局较差,手术死亡率高于非ECD患者.术后并发症的发生和ECD的诊断可预测阴性结果。
BACKGROUND: The traditional outcomes of the Fontan operation (FO) in endocardial cushion defect (ECD) patients have been suboptimal. Previous studies have been limited by the smaller number of ECD patients, longer study period with an era effect, and do not directly compare short-term outcomes of FO in ECD patients with non-ECD patients. Our study aims to address these shortcomings.
METHODS: A retrospective analysis of the Kids Inpatient Database (2009, 2012, and 2016) for the FO was done. The groups were divided into those who underwent FO with ECD as compared to non-ECD diagnosis. The data were abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used.
RESULTS: Three thousand three hundred eighty patients underwent the FO of which 360 patients (11%) were FO-ECD. ECD patients were more likely to have Down syndrome, Heterotaxy syndrome, transposition/DORV, and TAPVR as compared to non-ECD patients. FO-ECD had a higher discharge-mortality (2.84% vs. 0.45%, p = .04). The length of stay (16 vs. 13 days, p = .05) and total charges incurred ($283, 280 vs. $234, 106, p = .03) for the admission were higher in the FO-ECD as compared to non-ECD patients. In multivariable analysis, ECD diagnosis, cardiac arrest, acute kidney injury, and postoperative hemorrhage were predictors of mortality.
CONCLUSIONS: Contemporary outcomes for FO are excellent with very low overall operative mortality. However, the outcomes in ECD patients are inferior with higher operative mortality than in non-ECD patients. The occurrence of postoperation complications and a diagnosis of ECD were predictive of a negative outcome.