Korean J Thorac Cardiovasc Surg.  2006 Aug;39(8):579-587.

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

• Yun TJ
• Im YM
• Song KJ
• Jung SH
• Park JJ
• Seo DM
• Lee MS

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.

Keyword

Fontan procedure; Pulmonary vascular compliance; Pleural effusion

MeSH Terms

Cardiopulmonary Bypass
Central Venous Pressure
Chest Tubes
Compliance*
Drainage
Fontan Procedure*
Humans
Linear Models
Pleural Effusion*
Protein-Losing Enteropathies
Pulmonary Artery
Pulmonary Circulation
Pulmonary Embolism
Retrospective Studies
Risk Factors