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Univentricular heart and Fontan staging: analysis of factors impacting on body growth

Katrien Francois UGent, Thierry Bové UGent, Joseph Panzer UGent, Katya De Groote UGent, Kristof Vandekerckhove UGent, Hans De Wilde UGent and Daniël De Wolf UGent (2012) EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. 41(6). p.e139-e145
abstract
The optimal timing of the Fontan staging for a univentricular heart and its impact on growth remains debateable. In a Fontan cohort, the influence of staged interventions and patient factors on somatic development was explored. We reviewed 64 total cavopulmonary connection (TCPC) patients treated since 1992. Serial anthropometric parameters recorded from birth to the latest follow-up (mean 12.5 +/- 6.1 years) and at each intervention [neonatal surgery, bidirectional cavopulmonary anastomosis (BCPA), TCPC, catheter treatment] were converted to z-scores. The influence of saturation, heart failure treatment and surgery intervals on growth was determined. The mean z-scores for weight and height changed significantly at each surgery up to the TCPC (-0.3 +/- 1.2 and 0 +/- 1 at birth, -1.3 +/- 1.9 and -0.9 +/- 1.7 at neonatal surgery, -2.1 +/- 1.2 and -1.6 +/- 1.3 at the BCPA, -1.2 +/- 1.3 and -0.7 +/- 1.4 at the TCPC for weight and height, respectively; P < 0.05 for each interval), with the largest decline before the BCPA, and the most marked improvement before the TCPC. Z-scores did not change significantly after the TCPC. Younger age at the BCPA had a positive influence on the weight z-score at the TCPC (P < 0.05); somatic growth at the latest follow-up (FU) was negatively influenced by heart failure treatment (P < 0.05). Body growth is severely impaired in Fontan patients. A close interstage follow-up between the first surgery and the BCPA must be targeted at optimizing nutritional support to counter the important growth retardation occurring before the BCPA. The better catch-up growth at the TCPC when the BCPA is performed earlier in life supports the current trend to perform the BCPA at a younger age. Heart failure treatment after a Fontan completion is independently associated with decreased late somatic development.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
STAGED PALLIATION, INFANTS, OPERATION, CHILDREN, Fontan, SOMATIC GROWTH, Somatic development, Congenital heart disease, Univentricular heart
journal title
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Eur. J. Cardio-Thorac. Surg.
volume
41
issue
6
pages
e139 - e145
Web of Science type
Article
Web of Science id
000304194800002
JCR category
SURGERY
JCR impact factor
2.674 (2012)
JCR rank
32/195 (2012)
JCR quartile
1 (2012)
ISSN
1010-7940
DOI
10.1093/ejcts/ezs194
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2138955
handle
http://hdl.handle.net/1854/LU-2138955
date created
2012-06-11 13:36:24
date last changed
2012-09-25 09:42:15
@article{2138955,
  abstract     = {The optimal timing of the Fontan staging for a univentricular heart and its impact on growth remains debateable. In a Fontan cohort, the influence of staged interventions and patient factors on somatic development was explored. 
We reviewed 64 total cavopulmonary connection (TCPC) patients treated since 1992. Serial anthropometric parameters recorded from birth to the latest follow-up (mean 12.5 +/- 6.1 years) and at each intervention [neonatal surgery, bidirectional cavopulmonary anastomosis (BCPA), TCPC, catheter treatment] were converted to z-scores. The influence of saturation, heart failure treatment and surgery intervals on growth was determined. 
The mean z-scores for weight and height changed significantly at each surgery up to the TCPC (-0.3 +/- 1.2 and 0 +/- 1 at birth, -1.3 +/- 1.9 and -0.9 +/- 1.7 at neonatal surgery, -2.1 +/- 1.2 and -1.6 +/- 1.3 at the BCPA, -1.2 +/- 1.3 and -0.7 +/- 1.4 at the TCPC for weight and height, respectively; P {\textlangle} 0.05 for each interval), with the largest decline before the BCPA, and the most marked improvement before the TCPC. Z-scores did not change significantly after the TCPC. Younger age at the BCPA had a positive influence on the weight z-score at the TCPC (P {\textlangle} 0.05); somatic growth at the latest follow-up (FU) was negatively influenced by heart failure treatment (P {\textlangle} 0.05). 
Body growth is severely impaired in Fontan patients. A close interstage follow-up between the first surgery and the BCPA must be targeted at optimizing nutritional support to counter the important growth retardation occurring before the BCPA. The better catch-up growth at the TCPC when the BCPA is performed earlier in life supports the current trend to perform the BCPA at a younger age. Heart failure treatment after a Fontan completion is independently associated with decreased late somatic development.},
  author       = {Francois, Katrien and Bov{\'e}, Thierry and Panzer, Joseph and De Groote, Katya and Vandekerckhove, Kristof and De Wilde, Hans and De Wolf, Dani{\"e}l},
  issn         = {1010-7940},
  journal      = {EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY},
  keyword      = {STAGED PALLIATION,INFANTS,OPERATION,CHILDREN,Fontan,SOMATIC GROWTH,Somatic development,Congenital heart disease,Univentricular heart},
  language     = {eng},
  number       = {6},
  pages        = {e139--e145},
  title        = {Univentricular heart and Fontan staging: analysis of factors impacting on body growth},
  url          = {http://dx.doi.org/10.1093/ejcts/ezs194},
  volume       = {41},
  year         = {2012},
}

Chicago
FRANCOIS, KATRIEN, Thierry Bové, JOSEPH PANZER, Katya De Groote, KRISTOF VANDEKERCKHOVE, HANS DE WILDE, and Daniël De Wolf. 2012. “Univentricular Heart and Fontan Staging: Analysis of Factors Impacting on Body Growth.” European Journal of Cardio-thoracic Surgery 41 (6): e139–e145.
APA
FRANCOIS, KATRIEN, Bové, T., PANZER, J., De Groote, K., VANDEKERCKHOVE, K., DE WILDE, H., & De Wolf, D. (2012). Univentricular heart and Fontan staging: analysis of factors impacting on body growth. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 41(6), e139–e145.
Vancouver
1.
FRANCOIS K, Bové T, PANZER J, De Groote K, VANDEKERCKHOVE K, DE WILDE H, et al. Univentricular heart and Fontan staging: analysis of factors impacting on body growth. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. 2012;41(6):e139–e145.
MLA
FRANCOIS, KATRIEN, Thierry Bové, JOSEPH PANZER, et al. “Univentricular Heart and Fontan Staging: Analysis of Factors Impacting on Body Growth.” EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 41.6 (2012): e139–e145. Print.