초록접수 현황
| 17F-167 | 구연 미채택시 포럼 발표 |
Early and Late Outcomes after Late Bidirectional Cavopulmonary Shunt
Yu Rim Shin, Young-Hwan Park, Han Ki Park
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Purpose : Studies on patients undergoing bidirectional cavopulmonary shunt (BCPS) beyond their infancy are limited. This study is to evaluate the outcomes after late BCPS and their associated factors.
Methods : Medical records of patients who underwent BCPS after the first year of their lives between December 1990 and April 2016 were retrospectively reviewed.
Results : Fifty-one patients underwent BCPS after their infancy as a single ventricle palliation. Median age at the palliation was 25 months (12 months – 25 years). There were two early deaths after BCPS. A third of the patients needed pulsatility in addition to the cavopulmonary shunt. Thirty-eight (75%) patients were able to proceed to Fontan completion. Fenestration was made in 26 (68%) patients, and the mean Fontan pressure was 17 mmHg. Six late deaths (12%) were encountered. Every case of attempt and take-down of Fontan circuit after BCPS was related to late death. Heart transplantation was performed in two patients. Freedom from death or transplantation was 92% and 82% at 5-year and 10-year, respectively. Age at BCPS was not a risk factor for death or transplantation. However, the age at BCPS was a predictor for Fontan completion (odds ratio, 0.99; p = 0.02)
Conclusion : Late BCPS is associated with poor long-term survival and low chance of Fontan completion. However, death or transplantation was not associated with the age at BCPS. Fontan take-down was a strong risk factor for late death. Therefore, heart transplantation instead of Fontan completion should be considered as a reasonable option for patients after late BCPS with high risks.
Methods : Medical records of patients who underwent BCPS after the first year of their lives between December 1990 and April 2016 were retrospectively reviewed.
Results : Fifty-one patients underwent BCPS after their infancy as a single ventricle palliation. Median age at the palliation was 25 months (12 months – 25 years). There were two early deaths after BCPS. A third of the patients needed pulsatility in addition to the cavopulmonary shunt. Thirty-eight (75%) patients were able to proceed to Fontan completion. Fenestration was made in 26 (68%) patients, and the mean Fontan pressure was 17 mmHg. Six late deaths (12%) were encountered. Every case of attempt and take-down of Fontan circuit after BCPS was related to late death. Heart transplantation was performed in two patients. Freedom from death or transplantation was 92% and 82% at 5-year and 10-year, respectively. Age at BCPS was not a risk factor for death or transplantation. However, the age at BCPS was a predictor for Fontan completion (odds ratio, 0.99; p = 0.02)
Conclusion : Late BCPS is associated with poor long-term survival and low chance of Fontan completion. However, death or transplantation was not associated with the age at BCPS. Fontan take-down was a strong risk factor for late death. Therefore, heart transplantation instead of Fontan completion should be considered as a reasonable option for patients after late BCPS with high risks.
첨부파일 : abstract_신유림.pptx
책임저자: Han Ki Park
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Yu Rim Shin, E-mail : yull0629@yuhs.ac