Impaired systemic ventricular relaxation affects postoperative short-term outcome in Fontan patients

被引:37
作者
Border, WL
Syed, AU
Michelfelder, EC
Khoury, P
Uzark, KC
Manning, PB
Pearl, JM
机构
[1] Cincinnati Childrens Hosp Med Ctr, Div Cardiol, Cincinnati, OH 45229 USA
[2] Cincinnati Childrens Hosp Med Ctr, Div Cardiothorac Surg, Cincinnati, OH 45229 USA
关键词
D O I
10.1016/j.jtcvs.2003.06.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Systemic ventricular end-diastolic pressure has been used as a predictor of outcome in patients undergoing the Fontan operation. However, this index only evaluates late diastolic function and does not assess active ventricular relaxation during the phase of early diastole, a key component of systemic venous pathway flow. This study sought to examine whether impaired preoperative systemic ventricular relaxation, expressed as the time constant of isovolumic relaxation (tau), affects short-term postoperative outcome in Fontan patients. Methods: All patients who underwent Fontan operation between May 1998 and November 2001 were enrolled. Tau was calculated from digitized preoperative systemic ventricular pressure tracings. Standard preoperative invasive indices were also recorded and analyzed. These independent variables were then entered into a multiple stepwise regression model, with length of intensive care unit stay, length of hospital stay, and prolonged pleural effusion as outcome variables. Results: Twenty-seven patients fulfilled inclusion criteria. Systemic left ventricle predominated, and all patients had undergone prior staged palliation. Extracardiac Fontan was the commonest operative technique. Of the independent variables examined, tau was the only statistically significant predictor of length of intensive care unit stay (P <.001) and length of hospital stay (P =.002). None of the independent variables predicted pleural effusion greater than 10 days. Conclusions: Tau was the only significant preoperative invasive predictor of short-term outcome in the Fontan patients. This illustrates the importance of systemic ventricular relaxation and highlights the need for a more comprehensive assessment of diastolic function before the Fontan operation.
引用
收藏
页码:1760 / 1764
页数:5
相关论文
共 21 条
  • [1] CARDIAC ANATOMY IN PATIENTS UNDERGOING THE FONTAN PROCEDURE
    BARLOW, A
    PAWADE, A
    WILKINSON, JL
    ANDERSON, RH
    [J]. ANNALS OF THORACIC SURGERY, 1995, 60 (05) : 1324 - 1330
  • [2] CASTANEDA AR, 1992, CIRCULATION, V86, P80
  • [3] Improved early morbidity and mortality after fontan operation: The Mayo Clinic experience, 1987 to 1992
    Cetta, F
    Feldt, RH
    OLeary, PW
    Mair, DD
    Warnes, CA
    Driscoll, DJ
    Hagler, DJ
    Porter, CJ
    Offord, KP
    Schaff, HV
    Puga, FJ
    Danielson, GK
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 28 (02) : 480 - 486
  • [4] REGIONAL WALL-MOTION AND STRAIN ANALYSIS ACROSS STAGES OF FONTAN RECONSTRUCTION BY MAGNETIC-RESONANCE TAGGING
    FOGEL, MA
    GUPTA, KB
    WEINBERG, PM
    HOFFMAN, EA
    [J]. AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1995, 269 (03): : H1132 - H1152
  • [5] A STUDY IN VENTRICULAR-VENTRICULAR INTERACTION - SINGLE RIGHT VENTRICLES COMPARED WITH SYSTEMIC RIGHT VENTRICLES IN A DUAL-CHAMBER CIRCULATION
    FOGEL, MA
    WEINBERG, PM
    FELLOWS, KE
    HOFFMAN, EA
    [J]. CIRCULATION, 1995, 92 (02) : 219 - 230
  • [6] The mature of flow in the systemic venous pathway measured by magnetic resonance blood tagging in patients having the Fontan operation
    Fogel, MA
    Weinberg, PM
    Hoydu, A
    Hubbard, A
    Rychik, J
    Jacobs, M
    Fellows, KE
    Haselgrove, J
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1997, 114 (06) : 1032 - 1041
  • [7] SURGICAL REPAIR OF TRICUSPID ATRESIA
    FONTAN, F
    BAUDET, E
    [J]. THORAX, 1971, 26 (03) : 240 - +
  • [8] Fontan operation in five hundred consecutive patients: Factors influencing early and late outcome
    Gentles, TL
    Mayer, JE
    Gauvreau, K
    Newburger, JW
    Lock, JE
    Kupferschmid, JP
    Burnett, J
    Jonas, RA
    Castaneda, AR
    Wernovsky, G
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1997, 114 (03) : 376 - 391
  • [9] FONTAN OPERATION - INFLUENCE OF MODIFICATIONS ON MORBIDITY AND MORTALITY
    JACOBS, ML
    NORWOOD, WI
    [J]. ANNALS OF THORACIC SURGERY, 1994, 58 (04) : 945 - 952
  • [10] THE MODIFIED FONTAN OPERATION - AN ANALYSIS OF RISK-FACTORS FOR EARLY POSTOPERATIVE DEATH OR TAKEDOWN IN 702 CONSECUTIVE PATIENTS FROM ONE INSTITUTION
    KNOTTCRAIG, CJ
    DANIELSON, GK
    SCHAFF, HV
    PUGA, FJ
    WEAVER, AL
    DRISCOLL, DD
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1995, 109 (06) : 1237 - 1243