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(Circulation. 2006;114:I-56 – I-61.)
© 2006 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

Cara A. Garofalo, MD; Santos E. Cabreriza, MBA; T. Alexander Quinn, MS; Alan D. Weinberg, MS; Beth F. Printz, MD; Daphne T. Hsu, MD; Jan M. Quaegebeur, MD, PhD; Ralph S. Mosca, MD; Henry M. Spotnitz, MD

From the Departments of Surgery (S.E.C., J.M.Q., R.S.M.), Pediatrics (C.A.G., B.F.P., D.T.H.), and Biostatistics (A.D.W.), Columbia College of Physicians and Surgeons (H.M.S.) and Department of Bioengineering (A.Q.), Columbia University, New York, NY.

Correspondence to Henry M. Spotnitz, MD, Columbia University College of Physicians & Surgeons, 622 W 168th St, PH 14-103, New York, NY 10032. E-mail hms2{at}columbia.edu

Background— We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions.

Methods and Results— Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n =5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation P=e^ßA defined the ventricular stiffness constant, ß. Changes in ß and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n =11, P=0.023, mixed models methodology). Pre-bypass ß correlated well with duration of chest tube (CT) drainage (r=0.90, n =16), net perioperative fluid balance (r=0.71, n=14), and length of stay (LOS) (r=0.81, n =16). CT duration and LOS also correlated significantly with post-bypass ß (r=0.77 for both, n=11), but insignificantly with preoperative catheterization pressures.

Conclusions— Intraoperative ß predicts duration of CT drainage, net perioperative fluid balance, and LOS after the Fontan operation. These observations could improve risk stratification and clinical management of children at high-risk undergoing the Fontan operation.

Key Words: diastole • Fontan procedure • hemodynamics • mechanics • morbidity