Erken Fontan yetmezliğinin gelişiminde perioperatif faktörlerin analizi: Tek merkez deneyimi

Yıl 2025, Cilt: 35 Sayı: 3, 519 - 529, 30.06.2025

Mustafa Yılmaz , Başak Soran Türkcan , Ata Niyazi Ecevit , Alper Gürsu , Atakan Atalay

https://doi.org/10.54005/geneltip.1644893

Öz

Amaç: Fontan operasyonu sonrası erken Fontan yetmezliği (EFY) nadir izlenmektedir. Mortalite ve morbiditeyle sonuçlanabilecek bu komplikasyonla ilişkili perioperative faktörlerin incelenmesi erken tanı ve tedavi için önemlidir.
Gereç ve Yöntemler: 2019-2023 yılları arasında Fontan operasyonu geçirmiş tüm pediatrik hastalar retrospektif olarak incelendi.Hastaların preoperative demografik , ekokardiyografik, anjiografik verileri toplandı. Operatif ve postoperatif değişkenlere ait hastane verileri retrospektif olarak incelendi.Tüm bu değişkenler ile EFY gelişimi arasındaki ilişki araştırıldı.
Bulgular: Bu çalışmaya toplam 21 Fontan hastası dahil edilmiştir ve bunların onunda (%47,6) EFY gelişmiştir. Ameliyat sonrası dönemde üç hasta (%14,2) hayatını kaybetmiştir.. Hastaların %52,4'ü erkek olup, medyan yaş 4,5 yıl olarak belirlenmiştir. Bulgular arasında, ameliyattan sonraki ilk 24 saatteki maksimum vasoaktif-inotropik skor (maxVIS) (p=0,023) ve yoğun bakımdaki il arterial kan gazı laktat değerlerinin (p=0,019) EFY gelişen hastalarda anlamlı şekilde daha yüksek olduğu izlenmiştir. Ayrıca, böbrek replasman tedavisi (p=0,020) ve ekstrakorporeal membran oksijenasyonu (EKMO) ihtiyacının (p=0,020) EFY ile ilişkili olduğu saptanmıştır. Hemodinamik instabilite sebebiyle ekstübasyonun ertelenmesi EFY gelişim riskinin artışı ile ilişkili bulunmuştur.
Sonuçlar: Hastaların postoperatif ilk 24 saatteki maxVIS ve yoğun bakımda alınan ilk arter kan gazı laktat değerlerinin yüksek olması EFY gelişimi ile ilişkili bulunmuştur.Hemodinamik instabilite sebebiyle ekstübasyonun ertelenmesi EFY gelişimi için önemli bir risk faktörü olarak belirlenmiştir.

Anahtar Kelimeler

Pediatrik , Fontan , Erken Fontan yetmezliği

Analysis of perioperative factors in the development of early Fontan failure : a single-center experience

Öz

ABSTRACT
Aim
Early Fontan failure (EFF) after Fontan surgery is rarely observed. Examining perioperative factors associated with this complication, which can lead to mortality and morbidity , is crucial for early diagnosis and treatment.

Material and Methods
All pediatric patients who underwent Fontan surgery between 2019 and 2023 were retrospectively analyzed. Preoperative demographic, echocardiographic, and angiographic data were collected. Hospital data related to operative and postoperative variables were retrospectively examined. The relationship between these variables and the development of EFF was investigated.

Results
A total of 21 Fontan patients were included in this study, and 10 of them (47.6%) developed EFF. Postoperatively, three patients (14.2%) died. Of the patients, 52.4% were male, with a median age of 4.5 years. Among the findings, postoperative maximum vasoactive-inotropic score (maxVIS) within the first 24 postoperative hour (p=0.023) and initial blood gas lactate values (p=0,019) were significantly higher in patient who developed EFF. Furthermore, the need for renal replacement therapy (p=0.020) and extracorporeal membrane oxygenation (ECMO) (p=0.020) were found to be associated with EFF. Delay in extubation due to hemodynamic instability has been identified as a significant risk factor for the development of EFF.

Conclusion
The postoperative maxVIS value in postoperative 24 hour and initial lactate levels in intensive care unit were found to be associated with EFF development. Delay in extubation due to hemodynamic instability has been identified as a significant risk factor for the development of EFF.

Anahtar Kelimeler

Pediatric , Fontan , Early Fontan failure

Kaynakça

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