Long-term cardiopulmonary exercise capacity after modified Fontan operation

Eur J Cardiothorac Surg. 2010 Jan;37(1):204-9. doi: 10.1016/j.ejcts.2009.06.053. Epub 2009 Aug 14.

Abstract

Objective: Early circuit separation enhances the long-term success of Fontan haemodynamics. To test this hypothesis, we analysed the postoperative cardiopulmonary capacity in children and adults.

Patients: Spiroergometry was performed at least twice in 43 patients with a median age of 14 (range: 7-43) years, with a median time interval of 4.6 (1.1-10.4) years between early and late testing. Twenty-eight patients had been operated on in childhood and 15 as adults. The exercise capacity (W(max)) and oxygen consumption capacity (VO(2max)) were compared between children and adults.

Results: The VO(2max) in children early postoperatively was better than in adults (median 27.9 vs 22.9, p=0.032). Both VO(2max) (median 30.1 ml min(-1) kg(-1) vs 16.9 ml min(-1)kg(-1), p<0.001), and W(max) (median 2.2 W kg(-1) vs 1.4 W kg(-1), p<0.001) were significantly better in children late after surgery. In the patient group as a whole, there was a significant decrease of VO(2max) between early and later testing (median 26.5 l min(-1) kg(-1) vs 20.7 l min(-1) kg(-1), p<0.001).

Conclusions: Fontan palliation in early childhood results in better cardiopulmonary capacity during long-term follow-up. Regular surveillance of the physical capacity by spiroergometry is indispensable for the supervision of patients with Fontan haemodynamics.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Exercise Test / methods
  • Exercise Tolerance / physiology*
  • Female
  • Fontan Procedure / methods*
  • Heart Rate / physiology
  • Humans
  • Male
  • Oxygen Consumption / physiology
  • Postoperative Period
  • Young Adult