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Exercise Testing Identifies Patients at Increased Risk for Morbidity and Mortality Following Fontan Surgery.
MedLine Citation:
PMID:  21418537     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective.  The objective of this study was to examine the relationship between exercise test data and mortality in patients who have had the Fontan procedure. Design.  The study was designed as a retrospective cohort study. Setting.  The study was set in a tertiary care center. Patients.  All study participants were Fontan patients ≥16 years old who had cardiopulmonary exercise tests at our institution between November 2002 and March 2010. The first exercise test with adequate effort during the study period was retained for analysis. We enrolled 146 patients at a median age of 21.5 years (16.0-51.6); 15.8 years (1.2-29.9) after Fontan surgery. Outcome Measures.  The outcome measures were exercise test data (peak oxygen consumption, peak heart rate, etc.); mortality. Results.  Peak oxygen consumption averaged 21.2 ± 6.2 mL/kg/min, 57.1 ± 14.1% predicted. Follow-up data were collected 4.0 ± 2.0 years (range 0.3-7.7) after the exercise test. Sixteen patients (11%) died during follow-up; their peak oxygen consumption (16.3 ± 4.0 mL/kg/min) was significantly less than the survivors' (21.8 ± 6.2 mL/kg/min; P < .0001). Recursive partitioning and Cox proportional hazards modeling revealed that the hazard for death for patients with a peak oxygen consumption of <16.6 mL/kg/min was 7.5 (95% confidence interval: 2.6, 21.6; P < .0002) times that of patients with a higher peak oxygen consumption. Similarly, the hazard ratio for patients with peak-exercise heart rates of <122.5 bpm was 10.6 (3.0, 37.1; 0 < 0.0002). Data from exercise tests could also identify patients at increased risk for a combined morbidity/mortality end point. Conclusions.  In adults with Fontan surgery, exercise test data can identify patients at increased risk of midterm morbidity and mortality.
Authors:
Susan M Fernandes; Mark E Alexander; Dionne A Graham; Paul Khairy; Mathieu Clair; Elizabeth Rodriguez; Dorothy D Pearson; Michael J Landzberg; Jonathan Rhodes
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-21
Journal Detail:
Title:  Congenital heart disease     Volume:  -     ISSN:  1747-0803     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.
Affiliation:
Department of Cardiology, Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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