Impact of Age at Fontan Completion on Postoperative Hemodynamics and Long-Term Aerobic Exercise Capacity in Patients With Dominant Left Ventricle Shuichi.

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Impact of Age at Fontan Completion on Postoperative Hemodynamics and Long-Term Aerobic Exercise Capacity in Patients With Dominant Left Ventricle Shuichi Shiraishi, MD, Toshikatsu Yagihara, MD, Koji Kagisaki, MD, Ikuo Hagino, MD, Hideo Ohuchi, MD, Junjiro Kobayashi, MD, Soichiro Kitamura, MD The Annals of Thoracic Surgery Volume 87, Issue 2, Pages 555-561 (February 2009) DOI: 10.1016/j.athoracsur.2008.11.015 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Patients with dominant left ventricle with or without rudimentary right ventricle (ventricular volume <50% of predicted normal value) defined as dominant left ventricular type. These patients were divided into two groups—group A (<3 years of age; n = 32) and group B (≥3 years of age; n = 33)—based on age at total cavopulmonary connection (TCPC). The Annals of Thoracic Surgery 2009 87, 555-561DOI: (10.1016/j.athoracsur.2008.11.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Changes in ventricular end-diastolic volume (% of normal value) and ventricular end-diastolic pressure (mm Hg) before and at 1, 5, and 10 years after total cavopulmonary connection (TCPC) in group A (solid circles) and in group B (open circles). Groups did not significantly differ. The Annals of Thoracic Surgery 2009 87, 555-561DOI: (10.1016/j.athoracsur.2008.11.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Changes in ventricular ejection fraction (%) and cardiac index (L/min/m2) before total cavopulomnary connection (TCPC) and at 1, 5, and 10 years thereafter. Cardiac index was higher in group A (solid circles) than in group B (open circles) at 5 years (3.3 ± versus 2.9 ± 0.7 L/min/m2; p = 0.0133) and at 10 years (3.2 ± 0.5 versus 2.6 ± 0.7 L/min/m2; p = 0.0194) after TCPC. The Annals of Thoracic Surgery 2009 87, 555-561DOI: (10.1016/j.athoracsur.2008.11.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Age at total cavopulmonary connection (TCPC) weakly and inversely correlated with cardiac index at 5 years (R = −0.452, p = 0.0003) and 10 years (R = −0.491, p = 0.0072) after TCPC. The Annals of Thoracic Surgery 2009 87, 555-561DOI: (10.1016/j.athoracsur.2008.11.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Serial changes in cardiac index after total cavopulmonary connection (TCPC). The upper and lower graphs show groups A and B, respectively. Mean cardiac index between 10 and 15 years old was significantly higher in group A than in group B (3.1 ± 0.5 versus 2.6 ± 0.5 L/min/m2; p = 0.0008). The Annals of Thoracic Surgery 2009 87, 555-561DOI: (10.1016/j.athoracsur.2008.11.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Postoperative exercise capacity (peak oxygen consumption [% of normal]). This value was significantly higher in group A than in group B (61.3 ± 11.5 versus 51.9 ± 9.1; p = 0.0001). Age at Fontan completion and peak oxygen consumption also were inversely correlated (R = −0.374, p = 0.0006). (TCPC = total cavopulmonary connection.) The Annals of Thoracic Surgery 2009 87, 555-561DOI: (10.1016/j.athoracsur.2008.11.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions