Impact of Pulmonary Vascular Compliance on the Duration of Pleural Effusion Duration after Extracardiac Fontan Procedure / 대한흉부외과학회지

ABSTRACT

BACKGROUND: Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have poor surgical outcome; prolonged pleural drainage, protein losing enteropathy, pulmonary thromboembolism and death. We hypothesized that low pulmonary vascular compliance (PVC) is a risk factor for prolonged pleural effusion drainage after the Fontan operation. MATERIAL AND METHOD: A retrospective review of 96 consecutive patients who underwent the Extracardiac Fontan procedures (median age 3.9 years) was performed. Fontan risk score (FRS) was calculated from 12 categorized preoperative anatomic and physiologic variables. PVC (mm(2)/m(2) . mmHg) was defined as pulmonary artery index (mm(2)/m(2)) divided by total pulmonary resistance (W.U . m(2)) and pulmonary blood flow (L/min/m(2)), based on the electrical circuit analogue of the pulmonary circulation. Chest tube indwelling time was log-transformed (log indwelling time, LIT) to fit normal distribution, and the relationship between preoperative predictors and LIT was analyzed by multiple linear regression. RESULT: Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 mm(2)/mmHg/m(2) (median 24.8), 3 to 268 days (median 20 days), and 1.1 to 5.6 (mean 2.9, standard deviation 0.8), respectively. FRS, PVC, cardiopulmonary bypass time (CPB) and central venous pressure at postoperative 12 hours were correlated with LIT by univariable analyses. By multiple linear regression, PVC (p=0.0018) and CPB (p=0.0024) independently predicted LIT, explaining 21.7% of the variation. The regression equation was LIT=2.74-0.0158 . PVC+0.00658 . CPB. CONCLUSION: Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after the extracardiac Fontan procedure.