Exercise Testing Identifies Patients at Increased Risk for Morbidity and Mortality Following Fontan Surgery

Abstract

In adults with Fontan surgery, exercise test data can identify patients at increased risk of midterm morbidity and mortality.

Changing Indications for Pediatric Heart Transplantation

“…Exercise performance after palliation of complex congenital heart lesions such as the atrial switch procedure or the Fontan procedure is impaired, with a maximal oxygen consumption of ≈60% of predicted in asymptomatic patients. [64][65][66][67][68][69][70] A lower maximal oxygen consumption has been associated with worse outcomes in patients with a Fontan procedure. 69,70 A maximal oxygen consumption <50% of the expected for the congenital heart lesion has been proposed as an indication for listing.…”

“…[64][65][66][67][68][69][70] A lower maximal oxygen consumption has been associated with worse outcomes in patients with a Fontan procedure. 69,70 A maximal oxygen consumption <50% of the expected for the congenital heart lesion has been proposed as an indication for listing. 11 In some circumstances, this may result in a maximal oxygen consumption value lower than the 15-mL·kg −1 ·min −1 maximal oxygen consumption commonly used as an indication for transplantation in the adult heart failure population.…”

Exercise Standards for Testing and Training

“…351 Vȯ 2 max has been found to be an independent predictor of death or hospitalization in a variety of congenital heart defects, including tetralogy of Fallot, 352 repair of transposition of the great arteries, 353 and Fontan physiology. 354 Similarly, in a recent study, Fontan patients with a peak HR <123 bpm were found to have a 10.6-fold greater risk of death during a follow-up period of 4.0±2.0 years. 354 In that study, however, almost all of the patients with a low peak HR had undergone treatments for serious rhythm disturbances.…”

Late Consequences of the Fontan Operation

“…5 Reduced peak oxygen consumption is associated with increased mortality. 6 Thromboembolism is common. 7 A low flow venous state with potential for stasis, multiple suture sites, and synthetic materials, as well as a relatively low cardiac output, all increase the risk.…”