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Right arrow Congenital - cyanotic

J Thorac Cardiovasc Surg 2004;126:1760-1764
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Impaired systemic ventricular relaxation affects postoperative short-term outcome in Fontan patients

William L. Border, MBChBa, Aitizaz U. Syed, FRCS Edb, Erik C. Michelfelder, MDa, Philip Khoury, MSa, Karen C. Uzark, PhDa, Peter B. Manning, MDb, Jeffrey M. Pearl, MDb,*

a Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
b Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Received for publication September 6, 2002; revisions received April 28, 2003; accepted for publication June 9, 2003.

* Address for reprints: Jeffrey M. Pearl, MD, Associate Professor of Surgery, Division of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, OSB-3, Cincinnati, OH 45229-3039, USA
Pearj0{at}chmcc.org

OBJECTIVES: Systemic ventricular end-diastolic pressure has been used as a predictor of outcome in patients undergoing the Fontan operation. However, this index only evaluates late diastolic function and does not assess active ventricular relaxation during the phase of early diastole, a key component of systemic venous pathway flow. This study sought to examine whether impaired preoperative systemic ventricular relaxation, expressed as the time constant of isovolumic relaxation (tau), affects short-term postoperative outcome in Fontan patients.

METHODS: All patients who underwent Fontan operation between May 1998 and November 2001 were enrolled. Tau was calculated from digitized preoperative systemic ventricular pressure tracings. Standard preoperative invasive indices were also recorded and analyzed. These independent variables were then entered into a multiple stepwise regression model, with length of intensive care unit stay, length of hospital stay, and prolonged pleural effusion as outcome variables.

RESULTS: Twenty-seven patients fulfilled inclusion criteria. Systemic left ventricle predominated, and all patients had undergone prior staged palliation. Extracardiac Fontan was the commonest operative technique. Of the independent variables examined, tau was the only statistically significant predictor of length of intensive care unit stay (P < .001) and length of hospital stay (P = .002). None of the independent variables predicted pleural effusion greater than 10 days.

CONCLUSIONS: Tau was the only significant preoperative invasive predictor of short-term outcome in the Fontan patients. This illustrates the importance of systemic ventricular relaxation and highlights the need for a more comprehensive assessment of diastolic function before the Fontan operation.






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