When is the right time for Fontan conversion? The role of cardiopulmonary exercise test

Alexander Egbe, Heidi M. Connolly, Joseph A. Dearani, Crystal R. Bonnichsen, Talha Niaz, Thomas G. Allison, Jonathan N. Johnson, Joseph T. Poterucha, Sameh M. Said, Naser M. Ammash

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. Methods A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2). Results 75 patients CPET prior to FC; mean age 24 ± 6 years; 44 males (59%); and 51 (68%) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5 ± 3.4 ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56%) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43%). Baseline peak VO2 > 14 ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P = .02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67%) patients with improved EC vs 2 (8%) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P = .01). There were 10 (13%) perioperative deaths, and baseline peak VO2 ≤ 14 ml/kg/min was predictive of perioperative mortality (HR 3.74; P < .001). Conclusions Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.

Original languageEnglish (US)
Pages (from-to)564-568
Number of pages5
JournalInternational Journal of Cardiology
Volume220
DOIs
StatePublished - Oct 1 2016

Fingerprint

Exercise Test
Exercise
Oxygen Consumption
Odds Ratio
Survival
Mortality

Keywords

  • Cardiopulmonary exercise test
  • Exercise capacity
  • Fontan conversion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Egbe, A., Connolly, H. M., Dearani, J. A., Bonnichsen, C. R., Niaz, T., Allison, T. G., ... Ammash, N. M. (2016). When is the right time for Fontan conversion? The role of cardiopulmonary exercise test. International Journal of Cardiology, 220, 564-568. https://doi.org/10.1016/j.ijcard.2016.06.209

When is the right time for Fontan conversion? The role of cardiopulmonary exercise test. / Egbe, Alexander; Connolly, Heidi M.; Dearani, Joseph A.; Bonnichsen, Crystal R.; Niaz, Talha; Allison, Thomas G.; Johnson, Jonathan N.; Poterucha, Joseph T.; Said, Sameh M.; Ammash, Naser M.

In: International Journal of Cardiology, Vol. 220, 01.10.2016, p. 564-568.

Research output: Contribution to journalArticle

Egbe, A, Connolly, HM, Dearani, JA, Bonnichsen, CR, Niaz, T, Allison, TG, Johnson, JN, Poterucha, JT, Said, SM & Ammash, NM 2016, 'When is the right time for Fontan conversion? The role of cardiopulmonary exercise test', International Journal of Cardiology, vol. 220, pp. 564-568. https://doi.org/10.1016/j.ijcard.2016.06.209
Egbe, Alexander ; Connolly, Heidi M. ; Dearani, Joseph A. ; Bonnichsen, Crystal R. ; Niaz, Talha ; Allison, Thomas G. ; Johnson, Jonathan N. ; Poterucha, Joseph T. ; Said, Sameh M. ; Ammash, Naser M. / When is the right time for Fontan conversion? The role of cardiopulmonary exercise test. In: International Journal of Cardiology. 2016 ; Vol. 220. pp. 564-568.
@article{0c75fce3bb49406d81b2669cfbb90b8b,
title = "When is the right time for Fontan conversion? The role of cardiopulmonary exercise test",
abstract = "Background To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. Methods A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10{\%} increase in baseline peak oxygen consumption (VO2). Results 75 patients CPET prior to FC; mean age 24 ± 6 years; 44 males (59{\%}); and 51 (68{\%}) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5 ± 3.4 ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56{\%}) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43{\%}). Baseline peak VO2 > 14 ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P = .02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67{\%}) patients with improved EC vs 2 (8{\%}) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P = .01). There were 10 (13{\%}) perioperative deaths, and baseline peak VO2 ≤ 14 ml/kg/min was predictive of perioperative mortality (HR 3.74; P < .001). Conclusions Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.",
keywords = "Cardiopulmonary exercise test, Exercise capacity, Fontan conversion",
author = "Alexander Egbe and Connolly, {Heidi M.} and Dearani, {Joseph A.} and Bonnichsen, {Crystal R.} and Talha Niaz and Allison, {Thomas G.} and Johnson, {Jonathan N.} and Poterucha, {Joseph T.} and Said, {Sameh M.} and Ammash, {Naser M.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.ijcard.2016.06.209",
language = "English (US)",
volume = "220",
pages = "564--568",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - When is the right time for Fontan conversion? The role of cardiopulmonary exercise test

AU - Egbe, Alexander

AU - Connolly, Heidi M.

AU - Dearani, Joseph A.

AU - Bonnichsen, Crystal R.

AU - Niaz, Talha

AU - Allison, Thomas G.

AU - Johnson, Jonathan N.

AU - Poterucha, Joseph T.

AU - Said, Sameh M.

AU - Ammash, Naser M.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. Methods A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2). Results 75 patients CPET prior to FC; mean age 24 ± 6 years; 44 males (59%); and 51 (68%) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5 ± 3.4 ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56%) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43%). Baseline peak VO2 > 14 ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P = .02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67%) patients with improved EC vs 2 (8%) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P = .01). There were 10 (13%) perioperative deaths, and baseline peak VO2 ≤ 14 ml/kg/min was predictive of perioperative mortality (HR 3.74; P < .001). Conclusions Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.

AB - Background To determine if Fontan conversion (FC) resulted in improvement in exercise capacity (EC), and to determine the role of cardiopulmonary exercise test (CPET) in risk stratification of patients undergoing FC. Methods A retrospective review of patients who underwent CPET prior to FC at Mayo Clinic from 1994 to 2014. The patients who also underwent post-operative CPET were selected for the analysis of improvement in EC defined as 10% increase in baseline peak oxygen consumption (VO2). Results 75 patients CPET prior to FC; mean age 24 ± 6 years; 44 males (59%); and 51 (68%) were in NYHA III/IV prior to FC. Pre-operative peak VO2 was 15.5 ± 3.4 ml/kg/min. A comparison of pre- and post-FC CPET data was performed using 42 patients (56%) that underwent CPET after FC. Improvement in EC occurred in 18 of 42 patients (43%). Baseline peak VO2 > 14 ml/kg/min was associated with improved EC (hazard ratio [HR] 1.85; P = .02). Improvement in New York Heart Association (NYHA) class occurred in 12 (67%) patients with improved EC vs 2 (8%) without improved EC. Improvement in NYHA class was more likely to occur in patients with improved EC compared to those without improvement EC (odds ratio 4.11, P = .01). There were 10 (13%) perioperative deaths, and baseline peak VO2 ≤ 14 ml/kg/min was predictive of perioperative mortality (HR 3.74; P < .001). Conclusions Baseline peak VO2 was predictive of perioperative survival, and improvement in EC. Performance on CPET in failing Fontan patients might be a useful clinical parameter in determining appropriate timing of FC.

KW - Cardiopulmonary exercise test

KW - Exercise capacity

KW - Fontan conversion

UR - http://www.scopus.com/inward/record.url?scp=84978153714&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978153714&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2016.06.209

DO - 10.1016/j.ijcard.2016.06.209

M3 - Article

C2 - 27390988

AN - SCOPUS:84978153714

VL - 220

SP - 564

EP - 568

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -