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The Effect of Cardiac Rehabilitation in Paediatric Fontan Circulation Patients: A Prospective Intervention Study

Luna van de Ven1, Ana Clara Félix2,3, Joana Suarez2,3

  • 1Department of Paediatric Cardiology, Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 Utrecht, The Netherlands.

Medicina (Kaunas, Lithuania)
|October 26, 2024
PubMed

Insights

Cardiac rehabilitation (CR) significantly enhances exercise capacity and quality of life for Fontan procedure patients. This structured program shows promise for improving outcomes in individuals with univentricular heart physiology.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Rehabilitation
  • Congenital Heart Disease

Background:

  • The Fontan procedure, a palliative surgery for univentricular heart physiology, is associated with reduced exercise capacity and quality of life.
  • Evidence-based strategies are needed to improve long-term outcomes for Fontan survivors.
  • Cardiac rehabilitation (CR) is a potential intervention to mitigate these deficits.

Purpose of the Study:

  • To evaluate the impact of a structured cardiac rehabilitation program on exercise capacity and health-related quality of life (HRQOL) in Fontan patients.
  • To assess the safety and feasibility of CR in this specific patient population.
  • To inform the integration of CR into standard care for Fontan survivors.

Main Methods:

  • A cohort of ten Fontan patients (aged 8-30 years) underwent a structured CR program for at least three months.
  • The program included supervised aerobic and resistance training, alongside educational and nutritional guidance.
  • Assessments included cardiorespiratory fitness (VO2 max, %pred VO2), haemodynamics, daily activity, HRQOL (SF-36), and NT-proBNP levels.

Main Results:

  • Significant improvements were observed in cardiorespiratory fitness, including VO2 max (p=0.0089) and percent predicted VO2 (p=0.005).
  • All domains of the SF-36 questionnaire demonstrated significant gains in HRQOL (p < 0.001).
  • The CR program was safe, with high adherence (85-93%) and no adverse events reported; NT-proBNP levels also decreased.

Conclusions:

  • Cardiac rehabilitation significantly improves exercise capacity and HRQOL in Fontan patients, including those with a right systemic ventricle.
  • These findings support the integration of physical conditioning into the standard care of Fontan survivors.
  • Further research is warranted to optimize CR protocols and confirm long-term benefits for reducing morbidity and mortality.

Keywords:
Fontan procedureaerobic exercise trainingcardiac rehabilitationcardiorespiratory fitnessexercise capacityhealth-related quality of life

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