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Differences in Exercise Performance in Fontan Patients with Extracardiac Conduit and Lateral Tunnel: A FORCE Fontan
Laura Seese1, Mary Schiff1, Laura Olivieri1
1Faculty Pavilion, Suite FP5210, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224-1334, USA.
The extracardiac conduit (ECC) Fontan procedure shows slightly better exercise capacity than the lateral tunnel (LT) Fontan, particularly in heart rate response and oxygen saturation. However, the clinical significance of these differences is minimal, highlighting the need for more cardiopulmonary exercise testing (CPET) in Fontan patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiopulmonary Exercise Testing
Background:
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart defects.
- Two common surgical techniques are the extracardiac conduit (ECC) and the lateral tunnel (LT) methods.
- Understanding differences in long-term exercise capacity between these techniques is crucial for patient management.
Purpose of the Study:
- To compare exercise capacity between patients who underwent the extracardiac conduit (ECC) versus the lateral tunnel (LT) Fontan procedure.
- To identify specific cardiopulmonary exercise test (CPET) parameters that differ between the two Fontan surgical techniques.
Main Methods:
- A multi-institutional Fontan registry included 2169 patients (2000-2023).
- Age-matched cohorts of 235 LT and 235 ECC patients with available CPET data were analyzed.
- Cardiopulmonary exercise test (CPET) results were compared between the matched groups.
Main Results:
- ECC patients demonstrated higher peak heart rates and heart rates at ventilatory anaerobic threshold (VAT).
- ECC patients exhibited significantly higher oxygen saturations at peak exercise and baseline.
- VO2 at VAT was higher in the ECC group, though other parameters like peak VO2 and work rate were similar.
Conclusions:
- The extracardiac conduit (ECC) Fontan procedure is associated with statistically better exercise capacity parameters compared to the lateral tunnel (LT) method.
- The observed differences in exercise capacity between ECC and LT Fontan are small, potentially limiting clinical translation.
- The low proportion of patients with documented CPET underscores the need for routine CPET surveillance in Fontan survivors.
