The Journal of pediatrics · 2025
Growth Characteristics at Time of Fontan Procedure and Their Association with Long-Term Outcomes.
СтатьяПоддержка правительства СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Yang Yanxu, Luong Jackie, Suthar Divya, Knight Jessica H, Oster Matthew E, Alonso Alvaro, Kochilas Lazaros
Аннотация
OBJECTIVE: To assess whether somatic growth may predict long-term success after a Fontan procedure.
STUDY DESIGN: The National Death Index was used to track outcomes of Fontan procedures from 1982 through 2011, using data from the Pediatric Cardiac Care Consortium, a US-based registry. Kaplan-Meier plots and Cox models were used to compare outcomes by growth characteristics, adjusting for sex, dominant ventricle, and era.
RESULTS: Among 1461 patients (median age 3.12 years at Fontan evaluation), median z-scores indicated delayed growth: height-for-age z-score (HAZ) -0.66, weight-for-age z-score (WAZ) -0.81, and weight-for-height z-score (WHZ) -0.50. Systemic left ventricle (LV) patients had higher WAZ vs those with right (-0.66 vs -0.93, P < .01). Over 21.2 years of median follow-up through 2022, 78 in-hospital and 184 postdischarge deaths occurred. High WAZ tertile was associated with decreased in-hospital mortality or takedown (aOR vs low tertile: 0.54; 95% CI: 0.31-0.95, P = .03). Long-term survival was not universally linked to growth, but systemic LV patients with higher HAZ tertile had better 25-year survival (high 93.8% vs middle 92.2% and low 82.2%, P = .02). High HAZ and middle WAZ tertiles were associated with lower mortality (adjusted hazard ratio vs low tertiles: 0.42; 95% CI: 0.20-0.87, P = .02 and .52; 95% CI: 0.28-0.97, P = .04). Overweight (WHZ > 2) was associated with increased mortality (adjusted hazard ratio vs normal WHZ: 2.43; 95% CI: 1.15-5.14, P = .02).
CONCLUSIONS: Suboptimal growth is prevalent after Fontan procedure. Higher weight correlates with improved perioperative outcomes, and taller height and balanced growth are associated with improved long-term survival, particularly in patients with a systemic LV.
STUDY DESIGN: The National Death Index was used to track outcomes of Fontan procedures from 1982 through 2011, using data from the Pediatric Cardiac Care Consortium, a US-based registry. Kaplan-Meier plots and Cox models were used to compare outcomes by growth characteristics, adjusting for sex, dominant ventricle, and era.
RESULTS: Among 1461 patients (median age 3.12 years at Fontan evaluation), median z-scores indicated delayed growth: height-for-age z-score (HAZ) -0.66, weight-for-age z-score (WAZ) -0.81, and weight-for-height z-score (WHZ) -0.50. Systemic left ventricle (LV) patients had higher WAZ vs those with right (-0.66 vs -0.93, P < .01). Over 21.2 years of median follow-up through 2022, 78 in-hospital and 184 postdischarge deaths occurred. High WAZ tertile was associated with decreased in-hospital mortality or takedown (aOR vs low tertile: 0.54; 95% CI: 0.31-0.95, P = .03). Long-term survival was not universally linked to growth, but systemic LV patients with higher HAZ tertile had better 25-year survival (high 93.8% vs middle 92.2% and low 82.2%, P = .02). High HAZ and middle WAZ tertiles were associated with lower mortality (adjusted hazard ratio vs low tertiles: 0.42; 95% CI: 0.20-0.87, P = .02 and .52; 95% CI: 0.28-0.97, P = .04). Overweight (WHZ > 2) was associated with increased mortality (adjusted hazard ratio vs normal WHZ: 2.43; 95% CI: 1.15-5.14, P = .02).
CONCLUSIONS: Suboptimal growth is prevalent after Fontan procedure. Higher weight correlates with improved perioperative outcomes, and taller height and balanced growth are associated with improved long-term survival, particularly in patients with a systemic LV.