Laparoscopic Nissen fundoplication in infants with hypoplastic left heart syndrome

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• 作者：Brian T. Craig^a ; Eric J. Rellinger^a ; Bret A. Mettler^b ; Scott Watkins^c ; Brian S. Donahue^c ; Dai H. Chung^a ; ^{dai.chung@vanderbilt.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HLHS ; hypoplastic left heart syndrome ; BTS ; Blalock&ndash ; Taussig shunt ; RV&ndash ; PA ; right ventricle-to-pulmonary artery shunt (Sano shunt) ; SVR ; systemic vascular resistance ; PVR ; pulmonary vascular resistance ; RV ; right ventricular ; ECMO ; extracorporeal membrane oxygenation ; IAP ; intraabdominal pressure ; TEE ; transesophageal echocardiography ; ASA ; American Society of Anesthesiology ; OR ; operating room
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：51
• 期：1
• 页码：76-80
• 全文大小：201 K

文摘

Patients with hypoplastic left heart syndrome (HLHS) experience a higher risk for complications from gastroesophageal reflux, prompting frequent need for fundoplication. Patients between stage I and II palliation (“interstage”) are at particularly high operative risk because of the parallel nature of their pulmonary and systemic blood flow. Laparoscopic approach for fundoplication is common for pediatric patients. However, its safety in interstage HLHS is relatively unknown. We examined the perioperative physiologic burden of a laparoscopic fundoplication in HLHS patients.

Methods

All patients who underwent open or laparoscopic fundoplication during the interstage period at our institution since 2006 were reviewed. Perioperative physiologic data, echocardiographic findings, survival, and complications were collected from the anesthetic record and patient chart.

Results

Nineteen patients with HLHS had laparoscopic fundoplication, 13 (68%) during the interstage period, compared to 64 performed by the open approach. Ten (77%) of 13 interstage patients had perioperative hemodynamic instability. Incidence of instability between open and laparoscopic groups was not different. One laparoscopic patient required ECMO support for shunt thrombosis.

Conclusions

Despite a high incidence of hemodynamic instability, overall outcomes are consistent with those reported in the literature for this high-risk patient population. Laparoscopic approach for fundoplication during the interstage period appears to be a relatively safe option for these patients.