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Differences In Longitudinal Exercise Performance In Fontan Patients With Extracardiac Conduit And Lateral Tunnel Systemic Venous Pathway Strategies: A Force Fontan Registry Study
Laura Seese, MD, MS1, Victor Morell, MD
1, Mary Schiff
1, Jacqueline Kreutzer, MD
1, Luciana D. F. Da Silva, MD
1, Mario Castro-Medina, MD
1, Rahul Rathod, MD
2, Laura Olivieri
1, Adam Christopher, MD
1, Tarek Alsaied, MD
1.
1University of Pittsburgh - Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,
2Boston Children's Hospital, Boston, MA, USA.
Objective(s): To explore the differences in longitudinal exercise capacity in patients with extracardiac conduit (ECC) and Lateral Tunnel (LT) Fontan.
Methods: We identified
3,033 (48.2% LT (n=1464) and 51.8% ECC (n=1569)) patients who underwent Fontan from the years 2000 to 2023 for inclusion from the FORCE Fontan registry, a multicenter, international registry for longitudinal Fontan outcomes.
Results: Ventricular dominance, single ventricle ejection fraction, and indexed end diastolic volume were similar (p>0.05). LT patients were more likely to experience atrial tachyarrhythmias (26.2% (379) vs 11.0% (168), p<0.0001), but rates of plastic bronchitis, protein losing enteropathy, and heart transplantation were similar (p>0.05). Exercise stress testing (EST) demonstrated that ECC patients had higher peak heart rate (173 bpm [160,183] vs 164 bpm [145,173]), peak VO2 (25.1 [20.4,30.2] vs 27.7 [22.1,33.6], p<0.0001), and percent of predicted VO2 (62% vs 65%), all p<0.0001. Conversely, the LT patients had superior peak O2 pulse (9.6 [7.1,12.2] vs 8.5 [7.0,10.7], p=0.0002) and peak work rate (123 [90,155] vs 106 [85,136], p<0.0001). These findings must be interpreted considering LT patients presented for EST at an older age (20.4 years [15.6, 26.0] vs 15.5 years [12.6,19.0], p<0.0001).
Conclusions: At multi-decade follow-up each of these Fontan anatomies perform statistically superiorly for different EST variables and inferiorly for others, although the clinical differences are diminutive. Additionally, aside from atrial tachyarrhythmias, these patients have similar rates of Fontan-associated complications, which may negatively impact exercise capacity. This data suggests that both the LT and ECC have similar impairment in exercise capacity long term.
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