Outcomes of the Non-fenestrated Fontan Procedure at High Altitude
| Autor: | Orlando Tamariz-Cruz, Carlos A. Corona-Villalobos, Almudena March, Alexis Palacios-Macedo, Héctor Díliz-Nava, Antonio G. Cabrera, Violeta Castañuela, Fabiola Pérez-Juárez, Aric Araujo-Martínez, Javier Horacio López-Terrazas, Moisés Mier-Martínez, Luis García-Benítez |
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| Rok vydání: | 2019 |
| Předmět: |
Heart Defects
Congenital Male medicine.medical_specialty Adolescent medicine.medical_treatment Total cavopulmonary connection 030204 cardiovascular system & hematology Fontan Procedure Fontan procedure 03 medical and health sciences Hemoglobins 0302 clinical medicine Altitude Risk Factors Internal medicine medicine Humans Risk factor Child Mexico Retrospective Studies business.industry Functionally univentricular heart General Medicine Effects of high altitude on humans Oxygen medicine.anatomical_structure Treatment Outcome 030228 respiratory system Child Preschool Pediatrics Perinatology and Child Health Vascular resistance Cardiology Drainage Surgery Female Vascular Resistance Cardiology and Cardiovascular Medicine Fenestration business |
| Zdroj: | World journal for pediatriccongenital heart surgery. 10(5) |
| ISSN: | 2150-136X |
| Popis: | Background: Although high altitude has been considered a risk factor for the Fontan operation, and an indication for fenestration, there is a paucity of data to support its routine use. Fenestration, with its necessary right to left induced shunt, together with the lower partial pressure of oxygen found with progressive altitude, can significantly decrease hemoglobin oxygen saturation, and therefore, it would be desirable to avoid it. Objective: To analyze immediate and medium-term results of the non-fenestrated, extracardiac, Fontan procedure at high altitude. Methods: Retrospective analysis of data from consecutive patients who underwent non-fenestrated, extracardiac, Fontan procedure at two institutions located in Mexico City at 2,312 m (7,585 ft) and 2,691 m (8,828 ft) above sea level. High altitude was not considered a risk factor. Results: Thirty-nine patients were included, with a mean age of 6.7 years. Mean preoperative indexed pulmonary vascular resistance was 1.7 Wood units. Seventy-nine percent of the patients extubated in the operating room. There was one in-hospital death (2.56%) and one at follow-up. Median chest tube drainage time was 6.5 and 6 days for the right and left pleural spaces. Median oxygen saturation at discharge was 90%. At a median follow-up of six months, all survivors, except one, had good tolerance to daily life activities. Conclusions: The present study shows good short- and medium-term results for the non-fenestrated, extracardiac, Fontan operation at altitudes between 2,300 and 2,700 m and might favor this strategy over fenestration to improve postoperative oxygen saturation. Further studies to examine the long-term outcomes of this approach need to be considered. |
| Databáze: | OpenAIRE |
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