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Impact of Pulmonary Vascular Compliance on Pleural Effusion Duration after Extracardiac Fontan Procedure
T. J. Yun, Y. M. Im, S. H. Jung, J. J. Park, D. M. Seo, W. K. Jahng, Y. H. Kim, I. S. Park, J. K. Ko, M. S. Lee. Asan Medical Center, Seoul, Republic of Korea
BACKGROUND:
Preoperative risk analysis for Fontan candidates is still less than optimal in that patients with apparently low risks may have poor surgical outcome. We hypothesized that low pulmonary vascular compliance is a risk factor for prolonged pleural effusion drainage.
METHODS:
A retrospective review of 96 consecutive patients who underwent Extracardiac conduit Fontan procedure was performed. Median age at operation was 3.9 years. Fontan risk score (FRS) was calculated from the 12 categorized preoperative anatomic and physiologic variables. Pulmonary vascular compliance (PVC, mm2/m2•mmHg) was defined as pulmonary artery index (mm2/m2) divided by pulmonary vascular resistance (W.U•m2) and pulmonary blood flow (L/min/m2), 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.
RESULTS:
Preoperative PVC, chest tube indwelling time and LIT ranged from 6 to 94.8 mm2/mmHg/m2 (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 of LIT was as follows: LIT = 2.74 - 0.0158•PVC + 0.00658•ΧΠΒ.
CONCLUSIONS:
Low pulmonary vascular compliance is an important risk factor for prolonged pleural effusion drainage after extracardiac Fontan procedure.
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