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Somatic growth in single ventricle patients: A systematic review and meta-analysis
Jef Van den Eynde1,2,3, Simone Bartelse4, Friso M Rijnberg1
1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Somatic growth in single ventricle patients undergoing Fontan palliation shows initial deficits but improves after the Glenn procedure. Modifiers like nutrition and timely interventions can optimize growth outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Growth and Development Studies
Background:
- Fontan palliation is a complex surgical procedure for single ventricle congenital heart defects.
- Somatic growth is a critical concern for long-term outcomes in these patients.
- Understanding growth patterns and their modifiers is essential for clinical management.
Approach:
- A systematic review and meta-analysis of studies published between 2000 and 2021.
- Pooled height and weight z-scores at multiple time points (birth, Glenn, Fontan, >5 years post-Fontan).
- Meta-regression analysis to identify trends and modifiers of somatic growth.
Key Points:
- Height and weight z-scores significantly decrease from birth to the interstage period.
- A ~50% recovery in z-scores is observed after the Glenn procedure.
- Weight z-scores normalize by >10 years post-Fontan, but height remains reduced, leading to increased BMI.
- Modifiers include nutritional management, surgical timing, complication resolution, and obesity prevention.
Conclusions:
- This review provides a comprehensive map of somatic growth in single ventricle patients post-Fontan palliation.
- Identified modifiers offer potential targets for optimizing growth and clinical follow-up strategies.
- Data can serve as a benchmark for assessing and improving somatic development in this vulnerable population.
Aim:
To map somatic growth patterns throughout Fontan palliation and summarise evidence on its key modifiers.
Methods:
Databases were searched for relevant articles published from January 2000 to December 2021. Height and weight z scores at each time point (birth, Glenn procedure, Fontan procedure and >5 years after Fontan completion) were pooled using a random effects meta-analysis. A random effects meta-regression model was fitted to model the trend in z scores over time.
Results:
Nineteen studies fulfilled eligibility criteria, yielding a total of 2006 participants. The z scores for height and weight were markedly reduced from birth to the interstage period, but recovered by about 50% following the Glenn procedure. At >10 years after the Fontan procedure, the z scores for weight seemed to normalise despite persistent lower height, resulting in increased body mass index. The review revealed a number of modifiers of somatic growth, including aggressive nutritional management, timing of Glenn/Fontan, prompt resolution of complications and obesity prevention programmes in adolescence and adulthood.
Conclusion:
This review mapped the somatic growth of single ventricle patients and summarised key modifiers that may be amendable to improvement. These data provide guidance on strategies to further optimise somatic growth in this population and may serve as a benchmark for clinical follow-up.
