Abstract
Objective. Was to analyze the course of the postoperative period after Fontaine's operation and to identify factors that determine the possibility of early extubation.
Material and methods. A retrospective comparative study included 49 patients who underwent Fontaine's surgery from January 2011 to June 2019. Patients were divided into two groups: the first included 23 patients who used the fast-track protocol, the second – 26 patients requiring prolonged mechanical ventilation.
Results. Patients of the second group needed longer treatment in the intensive care unit (ICU) (p<0.001), however, the total duration of hospitalization did not differ significantly. Mortality among fast-track patients was 4.3% (1 case). The overall mortality rate was 2% (1 case). Using univariate analysis, some parameters had significant impact on probability of successful fast-track strategy in early Fontan survios. Mean pulmonary artery pressure (MPAP) less than 15 cm. at the preoperative stage increases the chance of successful early extubation by 2.34 times (odds ratio (OR) 2.34; 95% CI 1.19–4.99; p=0.02). An inotropic score at the end of surgery less than 5 increases the likelihood of early extubation by 1.98 times (OR 1.98; 95% CI 1.35–4.73; p=0.016). Hyperlactatemia intraoperatively over 5 mmol/L reduces the chance of a successful fast-track protocol by 51% (OR 0.66; 95% CI 0.05–0.91; p=0.035).
Conclusions. The use of the fast-track protocol after Fontaine's operation is accompanied by a more favorable course of the postoperative period and a shorter stay in the ICU. The estimation of some clinic and hemodynamic parameters before the Fontan operation made it possible to select patients for fast-track strategy that could, improve postoperative outcome in these patients.
About the authors
- Vladlen V. Bazylev, Dr. Med. Sc., Professor, Chief Physician, ORCID
- Alishir B.O. Gamzaev, Dr. Med. Sc., Professor of the Department of Radiology, Interventional and Cardiovascular Surgery of PRMU, Cardiovascular Surgeon of SССH named after academician B.A. Korolev, ORCID
