Exercise performance after univentricular palliation

Sachin Talwar; Manikala Vinod Kumar; Vishnubhatla Sreenivas; Vishwa Prakash Gupta; Shiv Kumary Choudhary; Balram Airan

doi:10.4103/apc.APC_43_17

Exercise performance after univentricular palliation

Ann Pediatr Cardiol. 2018 Jan-Apr;11(1):40-47. doi: 10.4103/apc.APC_43_17.

Authors

Sachin Talwar¹, Manikala Vinod Kumar², Vishnubhatla Sreenivas³, Vishwa Prakash Gupta², Shiv Kumary Choudhary², Balram Airan²

Affiliations

¹ Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
² Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: The optimal timing, need for primary/staged procedure in patients undergoing univentricular palliation, is debatable.

Aims: We performed this study to assess the exercise performance of patients undergoing various forms of univentricular palliation.

Setting and design: This was a retrospective, prospective comparative study conducted at a multispecialty tertiary referral center.

Patients and methods: Between January 2012 and June 2015, 117 patients undergoing either bidirectional Glenn (BDG) (n = 43) or Fontan (total cavopulmonary connection [TCPC]) (n = 74) underwent exercise testing.

Statistical analysis: Comparisons between subgroups for continuous data were made with Student's t-test if normally distributed and Wilcoxon rank-sum test otherwise. Tests between subgroups for qualitative data were made with Pearson's Chi-square test.

Results: Patients who underwent BDG with open antegrade pulmonary blood flow (APBF) had higher saturations (oxygen saturation [SpO₂]) compared to those without it (87.5 ± 5.0% vs. 81.1 ± 4.8%; P = 0.0001). However, we found no differences in exercise parameters of patients undergoing BDG with or without APBF. Extracardiac TCPC (n = 42) patients demonstrated better exercise capacity (15.0 ± 7.7 vs. 11.2 ± 6.2 min; P = 0.02) and increased SpO₂ on exercise (87.0 ± 8.0% vs. 83.4 ± 7.6%; P ≤ 0.05) compared to lateral tunnel TCPC (n = 32). Fenestrated TCPC (n = 30) patients had higher exercise capacity reflected by higher metabolic equivalents (METs) consumption (6.4 ± 2.3 vs. 5.2 ± 2.0 METs, P = 0.02), fewer pleural effusions (7.0 ± 3.2 vs. 9.2 ± 6.2 days, P ≤ 0.05), and lower hospital stay (9.5 ± 4.0 vs. 12.7 ± 7.7 days, P = 0.04) compared to nonfenestrated TCPC (n = 44) patients.

Conclusions: We observed no differences in exercise parameters of patients undergoing BDG with or without APBF. Extracardiac TCPC patients had better exercise capacity but longer postoperative hospital stay and pleural effusions than patients with lateral tunnel Fontan. Fenestrated TCPC patients seemed to fare better than nonfenestrated ones. Patients undergoing TCPC had better exercise capacity than patients undergoing BDG alone.

Keywords: Bidirectional Glenn; exercise performance; fontan operation; single ventricle.