Impact of pulsatile pulmonary blood flow on cardiopulmonary exercise performance after the Fontan procedure.

Klemm, Lukas; Klawonn, Frank; Röhlig, Christoph; Schaeffer, Thibault; Staehler, Helena; Heinisch, Paul Philipp; Piber, Nicole; Hager, Alfred; Ewert, Peter; Hörer, Jürgen; Ono, Masamichi

doi:10.1016/j.xjon.2023.08.012

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Dokumenttyp:: Journal Article
Autor(en):: Klemm, Lukas; Klawonn, Frank; Röhlig, Christoph; Schaeffer, Thibault; Staehler, Helena; Heinisch, Paul Philipp; Piber, Nicole; Hager, Alfred; Ewert, Peter; Hörer, Jürgen; Ono, Masamichi
Titel:: Impact of pulsatile pulmonary blood flow on cardiopulmonary exercise performance after the Fontan procedure.
Abstract:: OBJECTIVE: To evaluate the exercise capacity in patients following Fontan-Kreutzer, Fontan-Björk, and total cavopulmonary connection (TCPC). METHODS: Patients who performed exercise capacity tests at least once after the Fontan procedure between 1979 and 2007 were included. Patients after Fontan-Björk procedure were divided into 2 groups according to the pulmonary blood flow (PBF) pattern: patients with pulsatile PBF and those without. Peak oxygen uptake (VO2) was measured and percent-predicted VO2 was calculated. RESULTS: A total of 227 patients were nominated. The types of Fontan procedure included Fontan-Kreutzer in 48 (21.1%) patients, Fontan-Björk in 38 (16.7%); 11 (4.8%) with pulsatile PBF and 27 (11.9%) without pulsatile PBF; and TCPC in 141 (62.1%). Median age at the Fontan procedure was 4.5 years (interquartile range, 2.1-8.2 years). A total of 978 cardiopulmonary exercise tests were performed at median follow-up of 17.7 years (interquartile range, 11.3-23.4 years) postoperatively. Analysis using linear mixed-effects models demonstrated that percent-predicted VO2 was greater in patients with pulsatile PBF after Fontan-Björk compared with patients after other types of Fontan procedure (P < .001). The same results were obtained when the longitudinal percent predicted VO2 was performed using only patients with tricuspid atresia and double inlet left ventricle (P < .001). CONCLUSIONS: Among long-term survivors after various types of Fontan procedures, patients with pulsatile PBF after the Fontan-Björk procedure demonstrated better exercise performance compared to those after TCPC, those after the Fontan-Kreutzer procedure, and those after the Fontan-Björk procedure with non-pulsatile PBF. The results implicate the importance of pulsatile PBF to maintain the Fontan circulation.
Zeitschriftentitel:: JTCVS Open
Jahr:: 2023
Band / Volume:: 16
Seitenangaben Beitrag:: 811-822
Volltext / DOI:: doi:10.1016/j.xjon.2023.08.012
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/38204613
TUM Einrichtung:: Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)2023