Key result
Right ventricular morphology, higher pre-completion ventricular end-diastolic pressure, and lower oxygen saturations were associated with a worse functional state.
Cross-Sectional (n=476)
Yes
In Fontan survivors, worse long-term functional state is associated with right ventricular morphology, higher pre-operative ventricular end-diastolic pressure, lower pre-operative oxygen saturations, lower caregiver income, and post-operative arrhythmias.
Answers are grounded in this paper and cite their sources.
Right ventricular morphology and pre-Fontan hemodynamics may predict worse function in Fontan survivors; leaves open causality and needs prospective validation.
BACKGROUND: Despite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function. METHODS AND RESULTS: We analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by averaging the percentile ranks of ventricular ejection fraction, maximal consumption of oxygen, the physical summary score for the Child Health Questionnaire, and a function of brain natriuretic peptide. The mean calculated score was 49.5 plus or minus 17.3, with a range from 3 to 87. After adjustment for time since completion of the circulation, we found that a lower score, and hence worse functional state, was associated with: right ventricular morphology (p less than 0.001), higher ventricular end-diastolic pressure (p equals 0.003) and lower saturations of oxygen (p equals 0.047) prior to completion of the Fontan circulation, lower income for the caregiver (p equals 0.003), and, in subjects without a prior superior cavopulmonary anastomosis, arrhythmias after completion of the circulation (p equals 0.003). The model explained almost one-fifth (18%) of the variation in the calculated scores. The score was not associated with surgical centre, sex, age, weight, fenestration, or the period of stay in hospital after completion of the Fontan circuit. A validation model, using 71 subjects randomly excluded from initial analysis, weakly correlated (R equals 0.17, p equals 0.16) with the score calculated from the dataset. CONCLUSIONS: Right ventricular morphology, higher ventricular end-diastolic pressure and lower saturations of oxygen prior to completion of the Fontan circuit, lower income for the provider of care, and arrhythmias after creation of the circuit, are all associated with a worse functional state. Unmeasured factors also influence outcomes.
No takes yet. Share an insight, caveat, or question.
Williams et al. (2009) conducted a cross-sectional in Fontan circulation (n=476). Pre- and postoperative clinical characteristics was evaluated on Calculated functional score (average of percentile ranks of ventricular ejection fraction, maximal consumption of oxygen, physical summary score for CHQ, and BNP). Right ventricular morphology, higher pre-completion ventricular end-diastolic pressure, and lower oxygen saturations were associated with a worse functional state.
Synapse has enriched 10 related papers. Consider them for comparative context: