Risk Factors of Exercise Intolerance in Children and Adolescents After Total Cavopulmonary Connection.

(1)

Background

Exercise intolerance is a nearly ubiquitous consequence among patients who have undergone the total cavopulmonary connection (TCPC) or modified Fontan procedure; however, the specific factors influencing this condition-especially the impact of surgical timing and perioperative management-remain inadequately understood. (2)

Methods

From a retrospective cohort of 255 TCPC patients, 99 who had undergone cardiopulmonary exercise testing (CPET) were included. Patients were stratified into a normal exercise tolerance group (ET group, peak VO2 ≥ 80% predicted, n = 45) and an exercise intolerance group (EI group, peak VO2 < 80% predicted, n = 54). Univariate and multivariate logistic regression analyses were performed to identify risk factors for decreased exercise tolerance. (3)

Results

Patients in EI group were older at TCPC surgery (4.67 vs. 3.60 years, p = 0.004) and CPET (10.11 vs. 8.65 years, p = 0.01). They had longer operation time (312.14 vs. 267.53 min, p = 0.01), bypass time (122.26 vs. 103.59 min, p = 0.045), and higher rate of prolonged ICU stay (>3 days, 68.9% vs. 31.1%, p = 0.01). ROC analysis determined optimal surgical age cut-off at 3.81 years (AUC = 0.692, p = 0.001). Univariate analysis identified age ≥ 3.8 years, ICU stay > 3 days, longer operation/bypass times, and postoperative atrioventricular valve regurgitation as significant risk factors. Multivariate analysis confirmed age at TCPC ≥3.8 years (OR = 2.54, 95% CI: 1.01-6.42, p = 0.049) and ICU stay >3 days (OR = 2.61, 95% CI: 1.07-6.39, p = 0.04) as independent predictors of exercise intolerance. (4)

Conclusions

The delayed completion (beyond 3.8 years of age) of TCPC procedure and the occurrence of early postoperative complications are associated with reduced long-term exercise capacity.