title: Comparison of prognostic variables in children and adults with Fontan circulation.
abstract: BACKGROUND
  Non-cardiac complications, such as hepato-renal and metabolic problems, are emerging late after the Fontan operation due to its unique hemodynamics. Consequently, associations between clinical variables and postoperative outcome may change during the prolonged postoperative course.
  
  
  RESULTS
  To determine if child and adult Fontan patients differ in the impact of cardiac and non-cardiac variables on clinical outcome, we prospectively evaluated associations between hemodynamics, neurohumoral factors, exercise variables, hepato-renal function and metabolic variables and unscheduled hospitalization, including death in 167 consecutive child and 116 adult Fontan patients. When compared with child patients, the adult patients showed higher rates of medications, lower cardiac index, higher values of natriuretic peptides, greater renal dysfunction, more cholestatic livers, and more impaired responses to exercise (p<0.05-0.0001). During the follow-up of 3.7 ± 2.1 years, 64 clinical events (37 in adults), including 13 deaths, occurred. A high CVP and low arterial oxygen satutration strongly predicted the child events (p<0.001), whereas these prognostic parameters were marginal in the adults. Instead, renal dysfunction and metabolic abnormality predicted adult events (p<0.05). Neurohumoral activation, low albumin, hyponatremia, and impaired exercise variables equally predicted clinical events in child and adult Fontan patients.
  
  
  CONCLUSIONS
  Distinctive differences in predictive value of clinical variables exist between child and adult Fontan patients. In addition to cardiac issues, we should consider non-cardiac determinents of clinical outcome to maximize our efforts to improve prognosis for adult Fontan survivors.
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan. Electronic address: hohuchi@hsp.ncvc.go.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohuchi
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yasuda
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Miyazaki
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Iwasa
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Heima
authors.initials: H
authors.lastname: Sakaguchi
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Ono
authors.initials: O
authors.lastname: Shin
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Negishi
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Noritake
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects* / Q000401:mortality; D006351:Heart Valves / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology; D008099:Liver / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Adult; Child; Fontan; Non-cardiac; Prognosis