Body Mass Index Trajectory and Outcome Post Fontan Procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Growth and Development

Background:

• Single ventricle physiology presents significant challenges, particularly concerning early life growth failure.
• High morbidity and mortality rates are observed in the peri-surgical period for these patients.
• Long-term implications of infant growth and adult body mass index (BMI) in single ventricle survivors remain poorly understood.

Purpose of the Study:

• To model body mass index (BMI) trajectories in patients with a single ventricle who underwent the Fontan procedure.
• To identify differences in baseline characteristics and long-term clinical outcomes based on distinct BMI trajectories.
• To investigate the association between early life growth patterns and severe Fontan failure.

Main Methods:

• Retrospective analysis of 496 patients from the Australia and New Zealand Fontan Registry (1981-2018).
• Latent class growth analysis used to model BMI trajectories from infancy through adolescence (0-6 months, 6-60 months, 5-16 years).
• Comparison of trajectories against long-term incidence of severe Fontan failure (mortality, heart transplant, takedown, NYHA class III/IV).

Main Results:

• Three distinct BMI trajectories (lower, middle, higher) were identified for both male and female subjects across age groups.
• Patients in the lower BMI trajectory at 0-6 months had a higher likelihood of having an atriopulmonary Fontan.
• A lower BMI trajectory in early life was significantly associated with increased long-term mortality and severe Fontan failure; no association found for higher BMI trajectories or current BMI.

Conclusions:

• Poor growth during early infancy is a significant predictor of increased long-term severe Fontan failure in single ventricle patients.
• Distinct body mass index (BMI) trajectories can be identified and utilized to assess risk in larger, older patient cohorts.
• Further research into optimal BMI targets based on these trajectories may improve long-term patient outcomes.