Document Detail


Impact of age at Fontan completion on postoperative hemodynamics and long-term aerobic exercise capacity in patients with dominant left ventricle.
MedLine Citation:
PMID:  19161779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although the Fontan procedure is now being applied to younger patients, the influence of patients' age at the time of surgery on long-term results remains unclear. We investigated whether age at Fontan completion affects subsequent hemodynamics and exercise capacity in patients with a dominant left ventricle followed up for more than 5 years. METHODS: Between January 1990 and December 2001, 68 patients with a dominant left ventricle underwent total cavopulmonary connection (TCPC) at our institute. The survivors routinely underwent postoperative exercise tests and catheterization at 1 year and then every 5 years after TCPC, and were divided into group A (< 3 years; n = 32) and group B (> or = 3 years; n = 33), according to age at time of the Fontan procedure and retrospectively reviewed. We also examined the correlation between age at Fontan and data from postoperative catheterization or exercise tests. RESULTS: None of the patients died during a follow-up period of 91.2 +/- 46.7 months. The postoperative exercise capacity (peak oxygen consumption; % of normal [61.3 +/- 11.5 versus 51.9 +/- 9.1, p = 0.0001]), cardiac index at 5 years (3.31 +/- 0.62 versus 2.86 +/- 0.69, p = 0.0133) and at 10 years after TCPC (3.24 +/- 0.46 versus 2.61 +/- 0.65, p = 0.0194), and ventricular ejection fraction (%) at 10 years after TCPC (62.1 +/- 7.6 versus 53.0 +/- 8.0, p = 0.0131) were significantly higher in group A. Age at Fontan completion inversely correlated with postoperative peak oxygen consumption (R = -0.374, p = 0.0006) and cardiac index at 5 years (R = -0.452, p = 0.0003) and 10 years after TCPC (R = -0.491, p = 0.0072). CONCLUSIONS: Earlier TCPC is beneficial in the long term from the viewpoint of exercise capacity and hemodynamics among patients with a dominant left ventricle.
Authors:
Shuichi Shiraishi; Toshikatsu Yagihara; Koji Kagisaki; Ikuo Hagino; Hideo Ohuchi; Junjiro Kobayashi; Soichiro Kitamura
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  87     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-23     Completed Date:  2009-02-11     Revised Date:  2010-01-28    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  555-60; discussion 560-1     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Child, Preschool
Cohort Studies
Exercise Test
Exercise Tolerance / physiology*
Female
Follow-Up Studies
Fontan Procedure / methods*,  mortality
Heart Catheterization
Heart Defects, Congenital / diagnosis,  mortality,  surgery
Heart Ventricles / abnormalities*
Hemodynamics / physiology*
Humans
Infant
Kaplan-Meiers Estimate
Male
Oxygen Consumption / physiology
Postoperative Care / methods
Probability
Retrospective Studies
Risk Assessment
Survival Rate
Time Factors
Treatment Outcome
Tricuspid Atresia / mortality,  surgery*
Comments/Corrections
Comment In:
Ann Thorac Surg. 2010 Feb;89(2):675-6   [PMID:  20103388 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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