Cirugía del ventrículo único en la edad adulta. Una decisión meditada

Abstract

Introduction and objectivesTwo groups of adult patients participated in the single ventricle surgery: Those without surgery or only palliated with a fistula or pulmonary banding, and those having a cavopulmonary shunt performed in childhood, with failed functionality. An analysis was performed on our results with these patients, answering the question of whether surgery offers benefits when the natural history of the disease is advanced for the first group, and in those with a surgical history of a failed Fontan procedure in the second group. MethodsRetrospective descriptive study of all single ventricle patients older than 18years, operated on through cardiopulmonary bypass between 1993-2014. Analysis of risk factors related to mortality. ResultsTwo groups of patients, repeating one patient in both groups due to a sub-acute failed Fontan: Patients without surgery or only first stage palliated: 14 procedures/13 patients. Patients with failed Fontan: 6 procedures/5 patients. Hospital mortality: 2/20 (10%) procedures; 2/17 (11.8%) patients. Mean follow up 11years (0.5-21.5), without losses. Late mortality: 3 patients, 2 with Glenn procedure, 0 with primary Fontan procedure and 1 with Fontan revision procedure. The only significant risk factor for mortality was aortic clamping time (P=.02). The Glenn procedure as a definitive palliation compared with the Fontan procedure showed no significant differences in the survival rate (P=.49). ConclusionsFontan surgery performed in adults with single ventricle improves oxygenation, hyperviscosity and clinical status, but not ventricular function.Dysfunctional Fontan: A surgical revision is recommended if there are solvable anatomical problems with preserved ventricular function. In other cases we would prefer a cardiac transplant.