日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 32(4): 307-313 (2016)
doi:10.9794/jspccs.32.307

原著Original

当院におけるTCPC conversionの中期成績と効果の検討Midterm Surgical Outcomes and Effectiveness of Conversion Operations in Total Cavopulmonary Connection

石井 卓1，嘉川 忠博1，矢崎 諭1，斉藤 美香1，稲毛 章郎1，浜道 裕二1，上田 知実1，和田 直樹2，安藤 誠2，高橋 幸宏2，朴 仁三3Taku Ishii1, Tadahiro Yoshikawa1, Satoshi Yazaki1, Mika Saito1, Akio Inage1, Yuji Hamamichi1, Tomomi Ueda1, Naoki Wada2, Makoto Ando2, Yukihiro Takahashi2, In-Sam Park3

1 公益財団法人日本心臓血圧研究振興会附属榊原記念病院小児科Department of Pediatric Cardiology, Sakakibara Heart Institute ◇ Tokyo, Japan

2 公益財団法人日本心臓血圧研究振興会附属榊原記念病院心臓血管外科Department of Cardiovascular Surgery, Sakakibara Heart Institute ◇ Tokyo, Japan

3 東京女子医科大学病院心臓病センター循環器小児科Department of Pediatric Cardiology, Tokyo Women’s Medical University Hospital ◇ Tokyo, Japan

受付日：2016年3月2日Received: March 2, 2016
受理日：2016年6月10日Accepted: June 10, 2016
発行日：2016年7月1日Published: July 1, 2016
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背景：本研究の目的は，TCPC conversion手術の中期成績および効果を明らかにすることである．

対象と方法：2004年1月から2013年12月の間に当院でTCPC conversionを行った35例を後方視的に検討した．術前に高度の心不全，腎不全，肝硬変を認めた症例はなかった．また，35例中18例（51.4％）でなんらかの追加術式が行われていた．

結果：周術期に合併症を認めた症例は25例（71.4％）で，うち10例は上室性頻拍であった．周術期死亡は1例のみで退院後の死亡例は認めなかった．退院後の心血管event free survivalは5年で75.0％だった．NYHA classおよび不整脈頻度は術後に有意な改善を認めたが，術中不整脈治療の有無による周術期および退院後の上室性不整脈頻度の比較では有意差を認めなかった．術前後の心臓カテーテル検査では心係数（術前2.19±0.51 L/min/m2 vs術後2.85±0.84 L/min/m2，p＜0.01）および中心静脈圧（術前13.1±3.0 vs術後11.4±3.4, p＜0.02）の有意な改善を認めた．

結論：TCPC conversionは全身状態が良い症例では安全に施行可能で，血行動態および症状の改善が期待できる．

Background: The purpose of this study was to ascertain the effectiveness of total cavopulmonary connection (TCPC) by reviewing the midterm outcomes of TCPC conversion operations.

Method and Patients’ Background: We analyzed data for 35 patients who underwent TCPC conversion operations performed between January 2004 and December 2013 in our institute. No patients showed medication-refractory congestive cardiac failure, severe renal failure, or irreversible liver cirrhosis. Eighteen patients (51.4％) underwent additional surgical procedures, including arrhythmia surgery.

Results: Postoperative complications were observed in 25 patients (71.4％), with the most frequent complication being supraventricular tachyarrhythmia (n＝10). There was one case of in-hospital death and no deaths after discharge. The actuarial freedom from cardiac events was 75.0％ at 5 years after discharge. New York Heart Association functional class and the incidence of supraventricular tachyarrhythmia significantly improved after TCPC conversion. However, simultaneous arrhythmia surgery did not improve the incidence of supraventricular tachyarrhythmia during hospitalization or after discharge. Cardiac catheter investigation after TCPC conversion revealed a significant improvement in cardiac index (from 2.19±0.51 L/min/m2 to 2.85±0.84 L/min/m2, p＜0.01) and central venous pressure (from 13.1±3.0 to 11.4±3.4, p＜0.02).

Conclusion: TCPC conversion is safe and symptomatically effective for patients whose organ functions were preserved. TCPC conversion may contribute to improvement of patients’ blood circulation and general condition.

Key words: TCPC conversion; Fontan; mid-term outcomes; arrhythmia surgery; cardiac catheterization data

© 2016 特定非営利活動法人日本小児循環器学会© 2016 Japanese Society of Pediatric Cardiology and Cardiac Surgery

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