Ergometría en pacientes con bypass total de ventrículo venoso con tubo extracardíaco

摘要

Background During the last years, several modifications of the hemodynamic and surgical procedures have made it possible for patients, who were previously not eligible for total bypass of the venous ventricle with an extracardiac conduit, to undergo this type of surgery late. Objective To analyze the response to exercise stress test in patients who underwent total bypass of the venous ventricle (TBVV) with an extracardiac conduit (EC) after and before the age of 10 years. Material and Methods Forty nine patients were assessed and divided in two groups: group A (n=24) included patients electively operated (low risk) before the age of 10 years and group B (n=25) included patients who underwent surgery after the age of 10 years with more complex conditions (high risk); these patients included conversions of atriopulmonary anastomosis (APA). Results Current age (group A: 8.58±2.54 years, group B: 20.84±6.99 years) and surgical age (group A: 6.15±1.78 years, group B: 18.04±7.16 years) were significantly different (p<0.000001), but follow-up was similar in both groups (A: 2.49±1.51 years, B: 2.82±1.6 years). FC (expressed as a percentage of expected FC) was better in group A than in group B (A: 81.7±13.9 years, B: 60.24%±15.9%; p<0.000001). In all patients, StO2 (%) at rest and during maximal effort were compared; the latter was significantly lower (p<0.000001, 92%±4.77% versus 82.45%±7.39%) secondary to fenestration. Seven patients in group A (29%) and 15 in group B (60%) had arrhythmias. Conclusions During the same period of time of follow-up, the response to exercise was better in patients who underwent surgery earlier and with less risk factors. In addition, the incidence of arrhythmias is lower in this group of patients.