[III-P6-2-03] Fontan循環プロファイリングによる予後予測の有効性
Keywords:Fontan, hemodynamic, predictor
Background:Elevated Fontan pressure(FP) and increased cardiac index(CI) is known to be risk factors for worse outcome. Relationship between CI and systemic vascular resistance(SVR) is intriguing, since there are patients with high CI and low SVR. We hypothesized that hemodynamic profiling using CI and SVR be useful to predict the Fontan outcome. Methods:This was a retrospective study of Fontan patients who underwent catheterization at aged＜10 years at the Children’s Hospital of Michigan from 1980 to 2018. Hemodynamic profiling category was created based on CI and SVR:A(CI≧3&SVR≧20), B(CI＜3&SVR≧20), C(CI≧3&SVR＜20), D(CI＜3&SVR＜20). The primary outcome was freedom from death/heart transplant and FAD (protein losing enteropathy and plastic bronchitis). Kaplan-Meier survival curve analysis was used to compare the outcome between categories. Multivariable Cox regression was used to evaluate the risk factors.Results:A total of 83 patients underwent catheterization at age of 4.7 years(2-10). During the median follow up of 5.3 years, 12 patients had the endpoints. Category A/B/C/D included 4(5%)/15(18)/53(64)/11(13) patients respectively. Overall freedom from the endpoint was 77% at 10-year. Category D had significantly shorter freedom from the endpoint(p＜0.01). Final multivariable model identified short duration after Fontan operation(HR0.57,p＝0.01), Fontan pressure≧14 mmHg (3.48,p＝0.04), hemodynamic category D(3.09,p＜0.05) were the significant predictors.Conclusion:The hemodynamic profiling category may be useful to risk stratify the patients with Fontan operation.