Alexander C Egbe1, Heidi M Connolly2, Joseph A Dearani3, Crystal R Bonnichsen4, Talha Niaz5, Thomas G Allison6, Jonathan N Johnson7, Joseph T Poterucha8, Sameh M Said9, Naser M Ammash10. 1. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: egbe.alexander@mayo.edu. 2. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: connolly.heidi@mayo.edu. 3. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: jdearani@mayo.edu. 4. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. 5. Department of Pediatrics, Mayo Clinic, Rochester, MN, USA. Electronic address: niaz.talha@mayo.edu. 6. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: allison.thomas@mayo.edu. 7. Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA. Electronic address: johnson.jonathan@mayo.edu. 8. Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA. 9. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: said.sameh@mayo.edu. 10. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: ammash.naser@mayo.edu.
Abstract
BACKGROUND: To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. METHODS: A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2). RESULTS: 75 patients CPET prior to FC; mean age 24±6years; 44 males (59%); and 51 (68%) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5±3.4ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56%) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43%). Baseline peak VO2 >14ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P=.02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67%) patients with improved EC vs 2 (8%) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P=.01). There were 10 (13%) perioperative deaths, and baseline peak VO2 ≤14ml/kg/min was predictive of perioperative mortality (HR 3.74; P<.001). CONCLUSIONS: Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.
BACKGROUND: To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. METHODS: A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2). RESULTS: 75 patients CPET prior to FC; mean age 24±6years; 44 males (59%); and 51 (68%) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5±3.4ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56%) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43%). Baseline peak VO2 >14ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P=.02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67%) patients with improved EC vs 2 (8%) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P=.01). There were 10 (13%) perioperative deaths, and baseline peak VO2 ≤14ml/kg/min was predictive of perioperative mortality (HR 3.74; P<.001). CONCLUSIONS: Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.
Authors: Geoffrey D Huntley; Abhishek J Deshmukh; Carole A Warnes; Suraj Kapa; Alexander C Egbe Journal: Pediatr Cardiol Date: 2018-06-14 Impact factor: 1.655
Authors: Alexander C Egbe; Heidi M Connolly; William R Miranda; Naser M Ammash; Donald J Hagler; Gruschen R Veldtman; Barry A Borlaug Journal: Circ Heart Fail Date: 2017-12 Impact factor: 8.790
Authors: Alexander C Egbe; Patricia A Pellikka; William R Miranda; Crystal Bonnichsen; Yogesh N V Reddy; Barry A Borlaug; Heidi M Connolly Journal: Int J Cardiol Date: 2020-02-27 Impact factor: 4.164
Authors: Alexander C Egbe; Yogesh N V Reddy; Arooj R Khan; Mohamad Al-Otaibi; Emmanuel Akintoye; Masaru Obokata; Barry A Borlaug Journal: Int J Cardiol Date: 2018-11-15 Impact factor: 4.164