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Body Mass Index Trajectory and Outcome Post Fontan Procedure
Emma Payne1,2, Frances Garden3,4, Yves d'Udekem5
1The University of Sydney Sydney Australia.
Insights
Poor infant growth in single ventricle patients undergoing the Fontan procedure is linked to worse long-term outcomes. Early life body mass index (BMI) trajectories, not later BMI, predict severe Fontan failure.
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.
Abstract:
Background Patients with a single ventricle who experience early life growth failure suffer high morbidity and mortality in the perisurgical period. However, long-term implications of poor infant growth, as well as associations between body mass index (BMI) and outcome in adulthood, remain unclear. We aimed to model BMI trajectories of patients with a single ventricle undergoing a Fontan procedure to determine trajectory-based differences in baseline characteristics and long-term clinical outcomes. Methods and Results We performed a retrospective analysis of medical records from patients in the Australia and New Zealand Fontan Registry receiving treatment at the Royal Children's Hospital, The Children's Hospital at Westmead, Royal Melbourne Hospital, and Royal Prince Alfred Hospital from 1981 to 2018. BMI trajectories were modeled in 496 patients using latent class growth analysis from 0 to 6 months, 6 to 60 months, and 5 to 16 years. Trajectories were compared regarding long-term incidence of severe Fontan failure (defined as mortality, heart transplantation, Fontan takedown, or New York Heart Association class III/IV heart failure). Three trajectories were found for male and female subjects at each age group-lower, middle, higher. Subjects in the lower trajectory at 0 to 6 months were more likely to have an atriopulmonary Fontan and experienced increased mortality long term. No association was found between higher BMI trajectory, current BMI, and long-term outcome. Conclusions Poor growth in early life correlates with increased long-term severe Fontan failure. Delineation of distinct BMI trajectories can be used in larger and older cohorts to find optimal BMI targets for patient outcome.
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