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Risk Factors of Exercise Intolerance in Children and Adolescents After Total Cavopulmonary Connection
Xuwen Xiao1,2, Ge Fan2, Haifan Wen2
1Medical Education Center of Jinan University, Jinan University, Guangzhou 510632, China.
Journal of Cardiovascular Development and Disease
|May 26, 2026
Summary
Delayed total cavopulmonary connection (TCPC) surgery and early postoperative complications significantly reduce exercise tolerance in patients. Optimal surgical timing and prompt management of complications are crucial for improving long-term outcomes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Exercise Physiology
Background:
- Exercise intolerance is common after total cavopulmonary connection (TCPC) or modified Fontan procedures.
- Factors influencing this intolerance, particularly surgical timing and perioperative care, require further investigation.
Purpose of the Study:
- To identify risk factors for decreased exercise tolerance in patients who have undergone TCPC.
- To determine the impact of surgical timing and early postoperative complications on long-term exercise capacity.
Main Methods:
- Retrospective analysis of 99 patients who underwent cardiopulmonary exercise testing (CPET) after TCPC.
- Stratification into normal exercise tolerance (peak VO2 ≥ 80% predicted) and exercise intolerance (peak VO2 < 80% predicted) groups.
- Logistic regression and ROC analysis to identify predictors of exercise intolerance.
Main Results:
- Patients with exercise intolerance were older at TCPC surgery (4.67 vs. 3.60 years) and CPET (10.11 vs. 8.65 years).
- Longer operation/bypass times and prolonged ICU stay (>3 days) were associated with exercise intolerance.
- Multivariate analysis identified age at TCPC ≥3.8 years (OR=2.54) and ICU stay >3 days (OR=2.61) as independent predictors.
Conclusions:
- Delayed TCPC completion (beyond 3.8 years) is linked to reduced long-term exercise capacity.
- Early postoperative complications, such as prolonged ICU stay, are associated with decreased exercise tolerance.
- Optimizing surgical timing and perioperative management may improve exercise outcomes in TCPC patients.
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