Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Eisentopf, J.
Chirurgische Konzepte zur definitiven Palliation bei Patienten mit Singel Ventricle - Physiologie: Impact auf klinische Langzeitresultate
[ Dissertation ] Graz Medical University; 2008. pp.65.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Knez Igor
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- Abstract:
- BACKGROUND: Since the implementation of the Fontan procedure, several clinical factors have been linked to outcome. The Fontan operation eliminates the systemic hypoxemia and ventricular volume overload characteristic of prior forms of palliation, however, late outcome of systemic venous and right atrial hypertension were unknown when the procedure was initially proposed. A study of the outcome after Fontan completion was undertaken with particular attention to the influence of age, cardiac diagnosis and techniques of the Fontan procedure. METHODS: Review of all patients (N=81) undergoing Fontan procedure between 1989 and 2008 to identify predictors of outcome: late mortality rates were determined and present clinical status was ascertained in all patients. 53 (66%) patients underwent a TCPC (total cavopulmonary connection) and in 19 (24%) patients we performed an extracardiac Fontan procedure. Only 4 (5%) patients underwent a hemifontan procedure at our department. RESULTS: Late overall survival was 85.9%. Median age was 4.7 years (3.7) and median weight was 15.4 kgs (6,7). We lost 13 (16.5%) patients (eleven early and two late deaths). In extracardiac Fontanpatients mortality was 0%. After a mean follow up of 240 months 81% of all patients were in NYHA I and 19% in NYHA I-II. Reoperation and late complication rates steadily declined according to surgery modification. Late mortality was increased only in patients with important atrio-ventricular valve dysfunction and valve replacement. CONCLUSIONS: Our 20-year experience with modified Fontan procedure for tricuspid atresia and various forms of univentricular heart has resulted in improved outcome with most survivors now leading lives of good quality into adulthood. Two-stage repair, fenestration, and postoperative inhalative NO therapy has a positive influence on early and long-term survival.