Exercise capacity after total cavopulmonary anastomosis: a longitudinal paediatric and adult study.
ESC Heart Fail
; 9(1): 337-344, 2022 02.
Article
em En
| MEDLINE
| ID: mdl-34894102
ABSTRACT
AIMS:
Fontan palliation is a surgical strategy for patients with complex congenital heart disease, in whom biventricular circulation cannot be achieved. Long-term survival is negatively affected by the absence of sub-pulmonary ventricle and increased systemic venous pressure. Exercise capacity is a known predictor of overall survival and quality of life in congenital heart defects. We aim to track individual trends of peak oxygen uptake (VÌO2 peak) after total cavopulmonary connection (TCPC), identify predictors of deterioration, and derive a disease-specific reference VÌO2 peak dataset. METHODS ANDRESULTS:
A retrospective study of serial cardiopulmonary exercise testing (CPET) data, gathered from all patients who underwent TCPC in the Czech Republic between 1992 and 2016. Of 354 consecutive patients with TCPC, 288 (81.4%) patients underwent one or more CPETs yielding 786 unique VÌO2 peak values used as a reference dataset. Longitudinal data were available in 206 (58.2%) patients, who underwent a median (inter-quartile range) of 3.0 (2.0-5.0) CPETs over a mean (standard deviation) of 8.9 (5.5) years. The decline of exercise capacity with age was linear and not faster than in healthy peers (P = 0.47), but relative values of VÌO2 peak in TCPC patients were 12.6 mL/min/kg lower. Single ventricular morphology and pulmonary artery size had no significant influence on the exercise capacity dynamics. VÌO2 peak decline correlated negatively with the trend of body mass index z-score (P = 0.006) and was faster in women than men (P = 0.008).CONCLUSIONS:
Total cavopulmonary connection patients have significantly reduced exercise capacity. The age-related decline paralleled the healthy population and correlated negatively with the body mass index trend. The presented VÌO2 peak reference dataset may help the clinicians to grade the severity of exercise capacity impairment in individual TCPC patients.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Tolerância ao Exercício
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Técnica de Fontan
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Cardiopatias Congênitas
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Child
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article