Comparison Of Palliative Procedures For Pulmonary Atresia And Fenestration In The Application Of Modified Fontan

Objective The systemic-to-pulmonary shunt(SPS)and right ventricular to pulmonary artery(RV-PA)connection were made to pursue the goal of rehabilitate the dysplastic native PAs via establishment of antegrade blood flow.However,the application of these two palliative operations was still confusing.We made a comparision between the two operations to determine which way can provide more benefit for pulmonary atresia,ventricular septal defect(VSD)and major aortopulmonary collateral arteries(MAPCAs).Method From January 2011 to January 2016,44 patients underwent SPS and 54 patients underwent RV-PA connection were compared on the aspect of the perioperative data and follow-up data.The SPS patients had smaller preoperative pulmonary artery index(PAI)(68.57±38.25 vs.112.62±61.63 mm2/m2,p<0.01)and more MAPCAs(2.4±1.1 vs.1.8±1.5,p = 0.045)than the RV-PA connection patients.The follow-up time showed no significant difference between RV-PA connection patients and SPS patients(15.5±11.8 vs.11.4±10 years,p = 0.073).Results The SPS patients achieved shorter duration of intubation time(26.73±27.20 vs.40.88±36.93 hours,p=0.045),intensive care unit(ICU)stay(3.613.9 vs.5.7±5.5 days,p=0.033)and hospital stay(9.9±3.9 vs.14.7± 11.9,p = 0.014)than RV-PA connection patients.The cumulative complete repair rate and cumulative survival rate did not differ significantly between two groups.Conclusion The SPS was made in patients with smaller sized PAs and more MAPCAs,achieved better postoperative outcomes and conserved the pulmonary annule.In general,we deemed the SPS as a better way for the patients associated with pulmonay atrsia,VSD and MAPCAs.Objectives:This study assesses the effect of fenestraion on patients with different risk level and seeks the suitable candidates for the fenestration.Methods:183 patients from January 2004 to June 2013 undergoing an extracardiac Fontan operation were retrospectively selected for this study.We divided_the patients into low risk(93patients)and high risk(90 patients)-groups according to the risk factors recognized by the previous studies and then compared the perioperative data between the nonfenestrated and fenestrated patients in each group.Results:In both groups there was no significant-difference of preoperative and operative data between the nonfenestrated and fenestrated patients.The postoperative blood oxygen saturation of fenestrated patients was significantly lower(p<0.01)in each group.In the high risk group the chest tube volume(1153 ml vs.1739 ml,p=0.021)and chest tube_duration(11.9 days vs.17.0 days,p=0.028)of fenestrated patients were lower comparing to nonfenestrated patients,while the chest tube volume and_chest tube duration were similar between the nonfenestrated and fenestrated patients in the low risk group.The morbidity and mortality of nonfenestrated and fenestrated patients were similar in both groups(p>0.05).Conclusions:Although fenestration was associated with lower postoperative oxygen saturations,fenestration showed better postoperative outcomes regarding to the chest tube volume and duration for the high-risk patients.Considering the similar early postoperative outcomes of nonfenestrated and fenestrated patients in low risk group,our data indicate that_fenestration for the high-risk patients should be performed.