Age at Fontan procedure impacts exercise performance in adolescents: Results from the Pediatric Heart Network Multicenter study

作者：Madan Pankaj^*; Stout Karen K; Fitzpatrick Annette L

来源：American Heart Journal, 2013, 166(2): 365-+.

DOI：10.1016/j.ahj.2013.04.013

Background Most single ventricle patients undergo Fontan procedure in a staged manner. However, optimal timing of Fontan completion after an intermediate staging surgery is controversial. Therefore, we investigated the long-term impact of age at Fontan completion on the exercise performance in adolescents.
Methods We analyzed National Institutes of Health/National Heart, Lung and Blood Institute Pediatric Heart Network Fontan Cross-Sectional Study dataset consisting of children and adolescents 6 to 18 years of age recruited in 2003 to 2004. Multivariate linear regression techniques were used to evaluate association of age at Fontan procedure with percent predicted VO2 maximum, percent predicted maximum O-2 pulse, and heart rate reserve in patients who achieved ventilatory anaerobic threshold (VAT).
Results Of the 405 patients who had undergone only one Fontan operation and ramp cycle ergometry, 72% had prior intermediate surgery. Mean age at Fontan completion and exercise testing was 3.4+/-2 and 2.4+/-3.2 years. Three hundred twelve patients reached VAT suggesting adequate cardiopulmonary effort. In patients who reached VAT, each year increase in age at Fontan completion was associated with a decline of 1.5 (95% CI -2.5 to -0.5) points in percent-predicted VO2 maximum and a decline of 4.1 (95% CI -6.0 to -2.1) beat/min in heart rate reserve after adjusting for all pertinent variables.
Conclusions Fontan completion at a younger age is associated with better exercise performance in adolescents.

• 出版日期2013-8