van der Ven J P G, Kamphuis V P, van den Bosch E, Gnanam D, Terol C, Bogers A J J C, Breur J M P J, Berger R M F, Blom N A, Ten Harkel A D J, Koopman L, Helbing W A
Division of Pediatric Cardiology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands.
Netherlands Heart Institute, 3501 DG Utrecht, The Netherlands.
J Cardiovasc Dev Dis. 2023 Jul 7;10(7):289. doi: 10.3390/jcdd10070289.
Fontan patients undergo multiple cardiothoracic surgeries in childhood. Following these procedures, ventricular function is temporarily decreased, and recovers over months. This is presumably related to cardiopulmonary bypass, but this is incompletely understood. Throughout the Fontan palliation, cardiac function is also affected by volume unloading. We aimed to gain insight into the biological processes related to impaired ventricular function and recovery following Fontan palliations using a panel of biomarkers. Furthermore, we described changes in ventricular function across the Fontan palliation due to volume unloading. We performed a prospective multicenter observational study in patients undergoing partial (PCPC) or total cavo-pulmonary connection (TCPC). Patients underwent assessment-including echocardiography and blood sampling-before surgery (T1), at first follow-up (T2), and 1 year after their procedures (T3). Blood samples were analyzed using a biomarker panel (OLINK CVD-III). Ninety-two biomarkers were expressed as principal components (PC) to limit multiple statistical testing. We included 32 PCPC patients aged 7.2 [5.3-10.3] months, and 28 TCPC patients aged 2.7 [2.2-3.8] years. The single ventricular longitudinal strain (SV GLS) temporarily decreased for PCPC patients at T2 (-15.1 ± 5.6 (T1) to -13.5 ± 5.2 (T2) to -17.3 ± 4.5 (T3), < 0.047 for all differences), but not following TCPC. The serum biomarkers were expressed as 4 PCs. PC1, including biomarkers of cell-cell adhesion, was not related to any patient characteristic. PC2, including biomarkers of superoxide anion regulation, increased at T2. PC3, including biomarkers of cardiovascular development, related to the stage of Fontan palliation. PC4 was of uncertain biological or clinical significance. No PC was found that related to ventricular performance. The SV GLS was temporarily diminished following PCPC, but not following TCPC. Several biomarkers were related to post-operative stress and adaptation to the PCPC or TCPC circulation, but none were related to the outcome.
Fontan手术患者在儿童期接受多次心胸外科手术。这些手术后，心室功能会暂时下降，并在数月内恢复。这可能与体外循环有关，但对此尚未完全了解。在整个Fontan姑息治疗过程中，心脏功能也会受到容量卸载的影响。我们旨在通过一组生物标志物深入了解Fontan姑息治疗后心室功能受损及恢复相关的生物学过程。此外，我们描述了由于容量卸载导致的Fontan姑息治疗过程中心室功能的变化。我们对接受部分腔肺分流术（PCPC）或全腔静脉肺动脉连接术（TCPC）的患者进行了一项前瞻性多中心观察性研究。患者在手术前（T1）、首次随访时（T2）以及手术后1年（T3）接受评估，包括超声心动图检查和血液采样。使用生物标志物检测板（OLINK CVD-III）对血液样本进行分析。92种生物标志物被表示为主成分（PC），以限制多重统计检验。我们纳入了32例年龄为7.2[5.3 - 10.3]个月的PCPC患者和28例年龄为2.7[2.2 - 3.8]岁的TCPC患者。PCPC患者在T2时单心室纵向应变（SV GLS）暂时下降（从T1时的-15.1±5.6降至T2时的-13.5±5.2，再降至T3时的-17.3±4.5，所有差异均<0.047），但TCPC患者术后未出现这种情况。血清生物标志物被表示为4种主成分。PC1包括细胞间粘附生物标志物，与任何患者特征均无关。PC2包括超氧阴离子调节生物标志物，在T2时升高。PC3包括心血管发育生物标志物，与Fontan姑息治疗阶段相关。PC4的生物学或临床意义尚不确定。未发现与心室功能相关的主成分。PCPC术后SV GLS暂时降低，但TCPC术后未出现这种情况。几种生物标志物与术后应激以及对PCPC或TCPC循环的适应有关，但均与预后无关。
