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Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
Published on: May 2, 2025
Predictors of morbidity and mortality in contemporary Fontan patients: results from a multicenter study including
Gerhard-Paul Diller1, Alessandro Giardini, Konstantinos Dimopoulos
1Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and the National Heart & Lung Institute, Imperial College of Science and Medicine, Sydney Street, SW3 6NP London, UK. g.diller@imperial.ac.uk
European Heart Journal
|October 9, 2010
Summary
Exercise intolerance in Fontan patients is linked to hospitalizations, not death or transplant. Key risk factors for poor outcomes include arrhythmia and specific Fontan types.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Exercise intolerance is linked to worse outcomes in congenital heart disease.
- The Fontan procedure is a palliative surgery for complex single-ventricle defects.
- Identifying risk factors for Fontan patient outcomes is crucial.
Purpose of the Study:
- To determine if exercise intolerance predicts poor outcomes in Fontan patients.
- To identify risk factors for mortality, cardiac transplantation, and hospitalization in Fontan survivors.
Main Methods:
- Retrospective analysis of 321 Fontan patients undergoing cardiopulmonary exercise testing (CPET).
- Data collected from four European centers between 1997 and 2008.
- Follow-up for a median of 21 months to assess mortality, transplantation, and hospitalizations.
Main Results:
- CPET parameters, except heart rate reserve, correlated with hospitalization risk but not death or transplantation.
- Clinically relevant arrhythmia increased risk of death/transplantation 6-fold.
- Atriopulmonary/atrio-ventricular Fontan connections carried a 3.7-fold higher risk compared to total cavopulmonary connection.
- Combined risk factors (arrhythmia, specific Fontan type, heart failure) predicted a 25% 3-year mortality.
Conclusions:
- Most CPET parameters predict hospitalization, not mortality or transplantation, in contemporary Fontan patients.
- Decreased heart rate reserve, arrhythmia, atriopulmonary/atrio-ventricular Fontan, and heart failure indicate poor prognosis.
- These factors may identify Fontan patients needing closer medical or surgical management.
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