title: The impact of altitude on early outcome following the Fontan operation.
abstract: BACKGROUND
  The success of a Fontan circulation depends on several factors including low pulmonary vascular resistance. Pulmonary vascular resistance rises in response to hypoxia. Hypoxia is associated with altitude. Therefore, we wondered whether altitude is a risk factor for early failure after the Fontan operation. The aim was to test this hypothesis.
  
  
  METHODS
  Data were obtained from all published series of 'total cavopulmonary' Fontan operations since 1990. The early failure rate from each series and the altitude of the respective cities were recorded. Early failure was defined as death, takedown of Fontan, or transplantation during the same hospital admission. The association between altitude and failure rate was investigated by rank correlation and logistic regression.
  
  
  RESULTS
  24 series were identified from centres situated at altitudes ranging from sea level to 520 metres. The plot of failure rate versus altitude suggests that failure rate increases with altitude. Logistic regression did not fit the data adequately. This was possibly due to the influence of unmeasured and unknown factors affecting the results, as well as the fact that centres were not randomly chosen but were self-selected by virtue of publishing their results. However, Spearman's rank correlation was 0.74 (p = 0.001).
  
  
  CONCLUSIONS
  The early outcome of the Fontan circulation appears to be adversely affected by altitude.
authors.affiliation: Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. rezah@tiscali.co.uk
authors.forename: Amir-Reza D
authors.initials: AR
authors.lastname: Hosseinpour
authors.forename: Catherine
authors.initials: C
authors.lastname: Sudarshan
authors.forename: Paul
authors.initials: P
authors.lastname: Davies
authors.forename: Samer A M
authors.initials: SA
authors.lastname: Nashef
authors.forename: David J
authors.initials: DJ
authors.lastname: Barron
authors.forename: William J
authors.initials: WJ
authors.lastname: Brawn
mesh_terms: D000531:Altitude; D018729:Fontan Procedure; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome