Jan Müller1, Peter Ewert2, Alfred Hager2. 1. Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany; Institute of Preventive Pediatrics, Technische Universität München, München, Germany. Electronic address: j.mueller@tum.de. 2. Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany.
Abstract
OBJECTIVE: Many patients with congenital heart disease (CHD) require surgery to ensure survival into adulthood. But history of previous thoracotomies is associated with respiratory muscle weakness, impairments in chest wall compliance, and moderately to severely impaired lung function. This study evaluated the impact of thoracotomies on functional outcome in patients with CHD. PATIENTS AND METHODS: In total 1372 adolescents and adults with CHD (32.4±11.5 years, 624 female), who underwent spirometry and cardiopulmonary exercise testing in our institution from January 2010 to August 2015, were analyzed. RESULTS: After adjusting for confounding variables, with every thoracotomy the prevalence for a restrictive ventilatory pattern increased by 1.8-fold (CI: 1.606-2.050; p<0.001). The number of thoracotomies had no direct influence on an impaired exercise capacity in a multivariate model, but with every percentage point increase in forced vital capacity probability of impaired exercise capacity diminished (OR: 0.944, CI: 0.933-0.955, p<0.001). There was a moderate correlation of forced vital capacity and peak oxygen uptake (r=0.464, p<0.001). After a follow-up of 2.1±1.6 years 21 patients had died. Survival was only related to age (p<0.001) and peak oxygen uptake (p<0.001) after considering together with thoracotomies, oxygen saturation at rest and forced vital capacity in a multivariate model. CONCLUSIONS: Independent of CHD complexity and other risk factors, multiple thoracotomies lead to restrictive lung pattern. It could be suggested that those limitations in forced vital capacity contribute to impairments in exercise capacity, which turned out to be the strongest predictor for survival.
OBJECTIVE: Many patients with congenital heart disease (CHD) require surgery to ensure survival into adulthood. But history of previous thoracotomies is associated with respiratory muscle weakness, impairments in chest wall compliance, and moderately to severely impaired lung function. This study evaluated the impact of thoracotomies on functional outcome in patients with CHD. PATIENTS AND METHODS: In total 1372 adolescents and adults with CHD (32.4±11.5 years, 624 female), who underwent spirometry and cardiopulmonary exercise testing in our institution from January 2010 to August 2015, were analyzed. RESULTS: After adjusting for confounding variables, with every thoracotomy the prevalence for a restrictive ventilatory pattern increased by 1.8-fold (CI: 1.606-2.050; p<0.001). The number of thoracotomies had no direct influence on an impaired exercise capacity in a multivariate model, but with every percentage point increase in forced vital capacity probability of impaired exercise capacity diminished (OR: 0.944, CI: 0.933-0.955, p<0.001). There was a moderate correlation of forced vital capacity and peak oxygen uptake (r=0.464, p<0.001). After a follow-up of 2.1±1.6 years 21 patients had died. Survival was only related to age (p<0.001) and peak oxygen uptake (p<0.001) after considering together with thoracotomies, oxygen saturation at rest and forced vital capacity in a multivariate model. CONCLUSIONS: Independent of CHD complexity and other risk factors, multiple thoracotomies lead to restrictive lung pattern. It could be suggested that those limitations in forced vital capacity contribute to impairments in exercise capacity, which turned out to be the strongest predictor for survival.
Authors: Derek L Tran; Hannah Gibson; Andrew J Maiorana; Charlotte E Verrall; David W Baker; Melanie Clode; David R Lubans; Diana Zannino; Andrew Bullock; Suzie Ferrie; Julie Briody; Peter Simm; Vishva Wijesekera; Michelle D'Almeida; Sally E Gosbell; Glen M Davis; Robert Weintraub; Anthony C Keech; Rajesh Puranik; Martin Ugander; Robert Justo; Dominica Zentner; Avik Majumdar; Leeanne Grigg; Jeff S Coombes; Yves d'Udekem; Norman R Morris; Julian Ayer; David S Celermajer; Rachael Cordina Journal: Front Pediatr Date: 2022-01-06 Impact factor: 3.418
Authors: Lisette M Harteveld; Nico A Blom; J Gert van Dijk; Robert H Reijntjes; Paul J van Someren; Fabian I Kerkhof; Irene M Kuipers; Lukas A J Rammeloo; Eco J C de Geus; Arend D J Ten Harkel Journal: PLoS One Date: 2022-09-01 Impact factor: 3.752