Abstract 2206: Exercise Capacity and Quality of Life late after Fontan Surgery.
Objectives. Determine the exercise capacity and quality of life in a longitudinal cohort of Fontan patients and identify parameters influencing these outcomes.
Methods and Results. Fontan survivors operated in our institution and living in the same state were invited to participate in the study if they were aged more than 10 years, and free of arrhythmias. Thirty-six patients, 23 with a classical atrio-pulmonary connection (AP) and 13 with a lateral tunnel operation (LT) underwent transthoracic echocardiography, a cycloergometer exercise study, were tested for resting ANP and BNP levels, and completed the following quality of life measures: Short Form-36 Questionnaire, the Hopkins Symptom Checklist, the Dyadic Adjustment Scale and the Family Assessment Device. A mean of 17±4 years after Fontan, VO2max ranged between 14 and 34 ml/kg/min and anaerobic threshold (AT) between 11 and 34 ml/kg/min. Diastolic dysfunction was identified in 23 pts (E wave velocity z-score <−2: 17/23 pts with AP vs 6/13 pts with LT, p=0.1). ANP and BNP levels were elevated in AP Fontan and normal in LT (p0.1). The only factor predicting worse exercise capacity was the type of Fontan performed, with patients with lateral tunnel having better exercise capacity than those with atrio-pulmonary connections (percentage of predicted AT: 88±14% vs 72±14%, p<0.005; percentage of predicted VO2max: 62±8% vs 54±7%, p<0.005). Responses from quality of life measures placed our Fontan cohort within the normal population range. None of the pre and postoperative variables adversely affected patients’ quality of life.
Conclusion: Optimal blood streaming seems to be the most important determinant of exercise capacity late after Fontan surgery. Patients with lateral tunnel performed better than those with atrio-pulmonary connections. Despite limited exercise capacity, Fontan patients appear to have a normal quality of life, reflected in their reports of psychiatric symptoms and family relationships.