Abstract 12728: Impact of Cardiac Function and Hemodynamics on Mortality in Patients After the Fontan Operation
Background: High central venous pressure (CVP) with low cardiac output (CO) characterizes Fontan hemodynamics. However, the association of these characteristics with prognosis remains controversial, especially in adult patients.
Purpose: To elucidate associations of Fontan hemodynamics with the mortality.
Method and Results: We evaluated cardiac function and hemodynamics in 431 consecutive Fontan survivors (≥ 6 months), including 170 adults, that included CVP (mmHg), cardiac index (CI; L/min/m2), systemic ventricular end-diastolic volume index (EDVI; ml/m2) and ejection fraction (EF; %), and arterial oxygen saturation (SpO2; %). The latest variables were compared with the 5-year all-cause mortality. During follow-up, 22 child and 15 adult patients died. In child and adult patients, higher CVP (hazard ratio [HR]:1.36 and 1.29, respectively, p < 0.01-0.0001), larger EDVI (HR: 1.01 and 1.03, respectively, p < 0.01 for both) and lower SpO2 (HR: 0.93 and 0.90, p < 0.001 for both) predicted the mortality. Lower EF predicted the mortality only in child patients (HR: 0.42, p < 0.0001). There was an opposite impact of CI on mortality (p < 0.001), i.e., lower CI in child patients (HR: 0.40, 95% confidence interval: 0.20-0.79, p < 0.01), whereas higher CI in adult patients (HR: 2.21, 95% confidence interval: 1.13-4.07, p < 0.05) predicted the mortality and the cutoff value was 2.46 and 2.90, respectively.
Conclusions: High-CO-associated CVP with preserved EF predicted mortality in adult Fontan patients. The failing pathophysiology in some long-term Fontan survivors may differ from that in child patients although both of them have high CVP in common.
Author Disclosures: H. Ohuchi: None. Y. Hayama: None. J. Negishi: None. K. Noritake: None. A. Miyazaki: None. I. Shiraishi: None.
- © 2016 by American Heart Association, Inc.