Kawasaki Yuki, Sasaki Takeshi, Kobayashi Daisuke
Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, St Louis, MO, USA.
Cardiol Young. 2025 Feb 3:1-7. doi: 10.1017/S104795112500023X.
Cases of Fontan failure with normal Fontan pressure have been reported. This study aimed to identify catheterisation-derived haemodynamic predictors of heart transplantation/death, other than Fontan pressure, in late post-Fontan patients.
This retrospective study evaluated post-Fontan patients who underwent cardiac catheterisation at age ≥10 years between 1993 and 2018. The predictive effect of cardiac index-systemic vascular resistance index plot and perfusion pressure on freedom from the primary outcome (heart transplantation/death) was evaluated. Patients were categorised into haemodynamic categories A (cardiac index ≥ 3, systemic vascular resistance index ≥ 13), B (cardiac index < 3, systemic vascular resistance index ≥ 13), C (cardiac index ≥ 3, systemic vascular resistance index < 13), and D (cardiac index < 3, systemic vascular resistance index < 13).
In total, 79 patients (median age: 15.7 [range: 10.1-50.2] years) were included; of them, the primary endpoint occurred in 10 (13%; median follow-up: 1.9 [range: 0.1-18.8] years). Category C patients had significantly shorter freedom from the endpoint than categories A and B patients. Univariate analysis identified significant haemodynamic predictors, including Fontan pressure, pulmonary/systemic vascular resistance index, pulmonary/systemic flow, systemic arterial oxygen saturation, systemic venous oxygen saturation, systemic vascular resistance index, perfusion pressure, perfusion pressure < 53 mmHg, and category C. In multivariable analysis, perfusion pressure < 53 mmHg and category C emerged as predictors of heart transplantation/death alongside Fontan pressure.
Haemodynamic profiling of late post-Fontan patients using the cardiac index-systemic vascular resistance index plot can aid to comprehend the post-Fontan status and predict clinical prognosis.
有报道称存在Fontan压力正常但Fontan手术失败的病例。本研究旨在确定Fontan手术后期患者除Fontan压力外，通过导管插入术获得的心脏移植/死亡的血流动力学预测指标。
这项回顾性研究评估了1993年至2018年间年龄≥10岁接受心脏导管插入术的Fontan手术患者。评估了心脏指数-体循环血管阻力指数图和灌注压对无主要结局（心脏移植/死亡）的预测作用。患者被分为血流动力学类别A（心脏指数≥3，体循环血管阻力指数≥13）、B（心脏指数<3，体循环血管阻力指数≥13）、C（心脏指数≥3，体循环血管阻力指数<13）和D（心脏指数<3，体循环血管阻力指数<13）。
共纳入79例患者（中位年龄：15.7[范围：10.1 - 50.2]岁）；其中，10例（13%；中位随访时间：1.9[范围：0.1 - 18.8]年）发生了主要终点事件。C类患者无终点事件的时间明显短于A类和B类患者。单因素分析确定了显著的血流动力学预测指标，包括Fontan压力、肺/体循环血管阻力指数、肺/体循环血流量、体循环动脉血氧饱和度、体循环静脉血氧饱和度、体循环血管阻力指数、灌注压、灌注压<53 mmHg以及C类。多变量分析中，灌注压<53 mmHg和C类与Fontan压力一起成为心脏移植/死亡的预测指标。
使用心脏指数-体循环血管阻力指数图对Fontan手术后期患者进行血流动力学分析有助于了解Fontan手术后的状态并预测临床预后。
