Abstract 13486: Patient and Procedural Factors Are Associated With Autonomic and Endothelial Dysfunction in Adolescent and Young Adult Fontan Survivors
Introduction: Vascular dysfunction is associated with diminished functional capacity and quality of life in adolescent and young adult Fontan survivors. Patient and procedural factors associated with diminished endothelial and autonomic function have not been established.
Methods: Cross-sectional single-institution study of Fontan survivors ages 8-25 years. Anthropometric characteristics were obtained. Endothelial function was assessed with brachial flow mediated dilation (FMD) and peripheral arterial tonometry reactive hyperemia index (lnRHI; EndoPAT). Autonomic function was assessed by heart rate variability (HRV; SphygmoCor). Records were reviewed for anatomic, hemodynamic and surgical characteristics, which served as predictor variables while vascular measures served as outcome variables. Bivariate predictors (p<0.1) were candidates for inclusion in multivariable models. Model development utilized linear regression techniques.
Results: Sixty patients (52% male, 90% Caucasian) completed the protocol with a mean age of 13.9 ± 4.1 years and duration of Fontan circulation of 9.9 ± 4.2 years. Median weight was 43.5 (IQR 31.4, 58.3) kg and BMI was 18.7 (16.1, 22.6) kg/m2. A single left ventricle was present in 65%. Mean FMD was 10.2 ± 5.5% and lnRHI was 0.236 ± 0.398. Median HRV was 41.2 (29.4, 52.0) ms. Major determinants of FMD included height, total # of surgeries and stage I palliation length of stay (LOS) (R2 0.29, p<0.001), whereas determinants of lnRHI included prior Norwood procedure, systolic blood pressure, resting heart rate and oxygen saturation (SaO2), mixed venous SaO2 and cardiac index (CI) at pre-Fontan catheterization (cath) and total # of hospitalizations (R2 0.27, p=0.01). Major determinants of HRV included total duration of surgical circulatory arrest, CI at pre-Fontan cath and Fontan completion LOS (R2 0.39, p=0.006). Traditional cardiovascular risk factors including weight and BMI were not independent determinants.
Conclusions: Multiple patient and procedural factors are associated with diminished endothelial and autonomic function in adolescent and young adult Fontan survivors. Targeted intervention of modifiable risk factors may improve long-term vascular health and functional status.
Author Disclosures: B.H. Goldstein: Consultant/Advisory Board; Modest; St. Jude Medical, W.L. Gore, B.Braun Medical. B.S. Marino: None. Z. Gao: None. P.R. Khoury: None. M.A. Amos: None. W.A. Mays: None. G.R. Veldtman: Research Grant; Modest; United Therapeutics. A.N. Redington: None. E.M. Urbina: Research Grant; Modest; Atcor Medical.
- © 2016 by American Heart Association, Inc.