Cirurga de Fontan: estudo retrospectivo de casos do Instituto Nacional de Cardiologia anos 2007-2020
Cirurga de Fontan: estudo retrospectivo de casos do Instituto Nacional de Cardiologia anos 2007-2020
Data
2023
Autores
Santos, Renata Medina dos
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A cirurgia de Fontan é um tratamento para um grupo heterogêneo de pacientes que apresentam corações funcionalmente univentriculares, representando aproximadamente 10% de todas as cardiopatias congênitas. Há publicações de resultados mostrando decréscimo na mortalidade precoce de pacientes submetidos a cirurgia de Fontan ao longo do tempo em países desenvolvidos, porém há poucos relatos dos desfechos de morbimortalidade da cirurgia de Fontan em países em desenvolvimento.
Objetivos: O objetivo desse estudo é descrever o perfil dos pacientes pediátricos submetidos à cirurgia de Fontan em hospital público federal de referência para cardiopatias congênitas complexas no Brasil.
Método: Estudo observacional retrospectivo em centro único, por meio de revisão de prontuário de todas as crianças submetidas à cirurgia de Fontan, no período de agosto de 2007 até julho de 2020.
Resultados: No período,78 crianças foram submetidas à cirurgia de Fontan com conduto extracardíaco, sendo 52,6% do sexo feminino. A apresentação morfológica predominante foi atresia da valva tricúspide (55,1%), seguida de atresia pulmonar (43,6%) e estenose pulmonar (26,9%). A idade média no momento da cirurgia foi de 12,1 ± 3,2 anos. Todos os pacientes haviam sido submetidos a cirurgia da anastomose cavo-pulmonar bidirecional, esta com mediana de idade de 2,3 [1,6; 5,0] anos. Hematócrito médio pré-Fontan foi de 56,9 (± 5,0) % e saturação média de oxigênio de 78,6 (±7,4)%. A mediana da renda familiar foi de 1,8 [1,2; 2,6] salários mínimos. A mortalidade em 30 dias foi de 10/77 (13,0%). No teste de associação houve diferença de mortalidade em 30 dias entre os pacientes submetidos à cirurgia de Fontan até o ano de 2015 (22,9%) e depois de 2015 (4,8%), (p=0,037). Houve também diferença no percentual de pacientes extubados no centro cirúrgico entre esses dois períodos respectivamente 2,9% e 47,6% (p=0,001). Apenas insuficiência renal pós-operatória (22,9% vs. 4,8%%, p=0,037) e diálise pós-operatória (19,4 vs. 2,4%, p=0,021) foram diferentes entre os períodos, sendo mais frequente no primeiro.
Conclusões: Embora a média de idade do paciente durante a cirurgia de Fontan tenha sido elevada, houve decréscimo da mortalidade precoce ao longo do tempo e aumento do número de pacientes extubados no centro cirúrgico, concomitante ao aumento do número de cirurgias por ano.
Palavras-chave: cirurgia de Fontan; Mortalidade; Cardiopatias Congênitas, Coração Univentricular, Brasil
Introduction: Fontan surgery is a treatment for a heterogeneous group of patients who have functionally univentricular hearts, representing nearly 10% of all congenital heart defects. There are publications of results showing a decrease in early mortality of patients undergoing Fontan surgery over time in developed countries, but there are few reports of morbimortality outcomes of Fontan surgery in developing countries. Objectives: The aim of this study is to describe the profile of pediatric patients who underwent Fontan surgery in a reference federal public hospital for complex congenital heart diseases in Brazil. Method: Retrospective observational study in a single center, through a review of the medical records of all children who underwent Fontan surgery, from August 2007 to July 2020. Results: During the period, 78 children underwent Fontan surgery with an extracardiac conduit, 52.6% of whom were female. The predominant morphological presentation was tricuspid valve atresia (55.1%), followed by pulmonary atresia (43.6%) and pulmonary stenosis (26.9%). Mean age at surgery was 12.1 ± 3.2 years. All patients had undergone bidirectional cavo-pulmonary anastomosis surgery, the latter with a median age of 2.3 [1.6; 5.0] years. Mean pre-Fontan hematocrit was 56.9 (± 5.0)% and mean oxygen saturation 78.6 (±7.4)%. The median family income was 1.8 [1.2; 2.6] minimum wages. The 30-day mortality was 10/77 (13.0%). In the association test, there was a difference in 30-day mortality between patients who underwent Fontan surgery before the year 2015 (22.9%) and after 2015 (4.8%) (p=0.037). There was also a difference in the percentage of patients extubated in the operating room between these two periods, respectively 2.9% and 47.6% (p=0.001). Only postoperative renal failure (22.9% vs. 4.8%%, p=0.037) and postoperative dialysis (19.4 vs. 2.4%, p=0.021) were different between periods, with more frequent in the former. Conclusions: Although the mean age of the patient during Fontan surgery was high, there was a decrease in early mortality over time and an increase in the number of patients extubated in the operating room, concomitant with the increase in the number of surgeries per year. Keywords: Fontan Procedure; Mortality; Congenital Heart Defects; Univentricular Heart; Brazil
Introduction: Fontan surgery is a treatment for a heterogeneous group of patients who have functionally univentricular hearts, representing nearly 10% of all congenital heart defects. There are publications of results showing a decrease in early mortality of patients undergoing Fontan surgery over time in developed countries, but there are few reports of morbimortality outcomes of Fontan surgery in developing countries. Objectives: The aim of this study is to describe the profile of pediatric patients who underwent Fontan surgery in a reference federal public hospital for complex congenital heart diseases in Brazil. Method: Retrospective observational study in a single center, through a review of the medical records of all children who underwent Fontan surgery, from August 2007 to July 2020. Results: During the period, 78 children underwent Fontan surgery with an extracardiac conduit, 52.6% of whom were female. The predominant morphological presentation was tricuspid valve atresia (55.1%), followed by pulmonary atresia (43.6%) and pulmonary stenosis (26.9%). Mean age at surgery was 12.1 ± 3.2 years. All patients had undergone bidirectional cavo-pulmonary anastomosis surgery, the latter with a median age of 2.3 [1.6; 5.0] years. Mean pre-Fontan hematocrit was 56.9 (± 5.0)% and mean oxygen saturation 78.6 (±7.4)%. The median family income was 1.8 [1.2; 2.6] minimum wages. The 30-day mortality was 10/77 (13.0%). In the association test, there was a difference in 30-day mortality between patients who underwent Fontan surgery before the year 2015 (22.9%) and after 2015 (4.8%) (p=0.037). There was also a difference in the percentage of patients extubated in the operating room between these two periods, respectively 2.9% and 47.6% (p=0.001). Only postoperative renal failure (22.9% vs. 4.8%%, p=0.037) and postoperative dialysis (19.4 vs. 2.4%, p=0.021) were different between periods, with more frequent in the former. Conclusions: Although the mean age of the patient during Fontan surgery was high, there was a decrease in early mortality over time and an increase in the number of patients extubated in the operating room, concomitant with the increase in the number of surgeries per year. Keywords: Fontan Procedure; Mortality; Congenital Heart Defects; Univentricular Heart; Brazil
Description
Palavras-chave
Cirurgia de Fontan, Mortalidade, Cardiopatias Congênitas, Coração Univentricular, Brasil, Fontan Procedure, Mortality, Congenital Heart Defects, Univentricular Heart, Brazil
Citação
Santos RM. Cirurga de Fontan: estudo retrospectivo de casos do Instituto Nacional de Cardiologia anos 2007-2020. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2023.