The Impact of a Prior Norwood Procedure on Cardiac Transplantation in Failed Fontan Physiology  

作　　者：Ryan G.McQueen Nikki M.Singh Ronald K.Woods 

机构地区：[1]Medical College of Wisconsin,Herma Heart Institute at Children’s Wisconsin,Milwaukee,USA [2]Division of Pediatric Cardiology,Medical College of Wisconsin,Herma Heart Institute at Children’s Wisconsin,Milwaukee,USA [3]Division of Pediatric Cardiothoracic Surgery,Medical College of Wisconsin,Herma Heart Institute at Children’s Wisconsin,Milwaukee,USA

出　　处：《Congenital Heart Disease》2024年第3期257-266,共10页先天性心脏病（英文）

摘　　要：Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a prior Norwood(FF).Methods:A single-institution retrospective review of all patients with Fontan failure who under-went cardiac transplantation from 2003–2021 was completed-22 underwent prior Norwood(FFN)and 11 did not(FF).Descriptive and inferential statistics were calculated for operative course and patient outcomes.Results:The operative course of the FFN cohort appeared to be more complex(not statistically significant,but clinically relevant)-this group exclusively experienced sternal re-entry events(3 of 22 patients)and concomitant neo-aor-tic reconstruction(6 patients),had a longer duration of surgery(median of 682 min vs.575.5 min),more time on circulatory arrest(median of 25.5 min vs.12.5 min),and more frequent use of open sternal management[50%of patients(11/22)vs.27.3%of patients(3/11)].Postoperatively,these patients underwent more mediastinal explora-tions[other than sternal closure;40.9%of patients(9/22)vs.18.2%of patients(2/11)],spent more time on mechanical ventilation(median of 5 days vs.2 days),had a longer length of stay(median of 30 days vs.19 days),and required more catheter-based re-interventions[22.7%of patients(5/22)vs.9.1%of patients(1/11)].Conclu-sion:Although underpowered,our results suggest that the operative course of FFN patients is more challenging,based mostly on neo-aortic arch issues.In turn,this likely leads to a more complex postoperative course.We are currently collaborating with other institutions to increase the cohort size and power of the study.

关 键 词：FONTAN Fontan failure NORWOOD cardiac transplantation 

分 类 号：R654.2[医药卫生—外科学]