Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study

Area of Science:

• Cardiology
• Biomarker Research
• Pediatric Cardiac Surgery

Background:

• Fontan palliation involves multiple surgeries, impacting ventricular function.
• Cardiopulmonary bypass and volume unloading effects on cardiac function are not fully understood.
• Understanding biological processes in Fontan patients is crucial for improving care.

Purpose of the Study:

• To investigate biological processes affecting ventricular function and recovery post-Fontan palliation.
• To describe changes in ventricular function due to volume unloading during Fontan palliation.
• To identify biomarkers related to ventricular function and recovery in Fontan patients.

Main Methods:

• Prospective, multicenter observational study.
• Included patients undergoing partial (PCPC) or total cavo-pulmonary connection (TCPC).
• Assessed echocardiography and serum biomarkers (OLINK CVD-III) at three time points.

Main Results:

• Single ventricular longitudinal strain (SV GLS) temporarily decreased post-PCPC, but not post-TCPC.
• Biomarker analysis revealed four principal components (PCs); PC2 (superoxide anion regulation) increased post-surgery.
• No identified biomarker PCs correlated with ventricular performance or clinical outcomes.

Conclusions:

• SV GLS is temporarily impaired after PCPC, highlighting surgical impact.
• Biomarkers reflect post-operative stress and adaptation but do not predict outcomes.
• Further research is needed to link biomarkers to ventricular function and recovery in Fontan patients.