Outcomes of the Conversion of the Fontan-Kreutzer Operation to a Total Cavopulmonary Connection for the Failing Univentricular Circulation

Abstract Background: The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment. Objective: To evaluate the results of conversion from FK to TCPC. Methods: A retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05. Results: Fontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured. Conclusions: The conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.

摘要：
背景：方坦-克罗伊策手术（Fontan-Kreutzer procedure，FK）曾在过去被广泛应用，但长期随访可引发多种并发症，进而导致单心室循环衰竭。转为全腔静脉肺动脉连接术（total cavopulmonary connection，TCPC）是可供选择的治疗方案之一。
目的：评估方坦-克罗伊策手术转为全腔静脉肺动脉连接术的临床效果。
方法：对1985年至2016年间接受方坦-克罗伊策手术转全腔静脉肺动脉连接术的患者的病历资料进行回顾性分析，检验水准设定为P<0.05。
结果：此研究时段内共有420例患者接受方坦类手术，其中320例行全腔静脉肺动脉连接术，82例行侧隧道技术术式，18例行方坦-克罗伊策手术。方坦-克罗伊策手术组中有10例患者接受了转全腔静脉肺动脉连接术治疗，本研究纳入所有接受该转流手术的患者。其中9例患者的手术指征为难以控制的心律失常，1例为蛋白丢失性肠病。前2例患者术后出现死亡。患者的重症监护病房（intensive care unit，ICU）平均停留时长（length of stay，LOS）为13天，住院平均停留时长为37天。80%纽约心脏协会（New York Heart Association，NYHA）心功能分级为Ⅰ或Ⅱ级的患者心功能得到改善。因心律失常接受转流术的患者中，57%的心律失常症状得到改善，4例患者完全治愈。
结论：方坦-克罗伊策手术转全腔静脉肺动脉连接术是一项复杂的手术操作，需由经验丰富的三级医院开展。尽管心律失常的转归仍未达到令人满意的水平，但该转流术可改善患者的纽约心脏协会心功能分级。