Fontan Prosedürü Uygulanmış Tek Ventriküllü Hastaların Retrospektif Değerlendirilmesi ve Prognostik Faktörlerin Belirlenmesi

Abstract

Fontan operation is a palliative surgical procedure performed in patients with a functional or anatomic single ventricle. In recent years, the types of malformations have expanded significantly in which Fontan operation used, and Fontan operation has become the most common surgery performed for patients with any single ventricle type. With the development of surgical techniques over the years, different types of Fontan procedure have begun to be performed. Due to steady improvement in survival, patients undergoing the Fontan procedure are at significant risk of morbidity in long-term. After the Fontan operation, patients usually do limited aerobic activity because of fear, however it is thought that the peripheral muscles may have positive effects on the Fontan circulation. In our study, the evaluation of the demographic and clinical characteristics of 56 patients who have undergone Fontan operation, who have been followed up in Hacettepe University İhsan Doğramacı Children's Hospital Pediatric Cardiology outpatient clinic since 2000, the comparison of pre and postoperative echocardiography and clinical findings, the determination of accompanying cardiac problems and other surgical interventions, to compare the data with previous studies and to contribute to the literature have been aimed. Biochemical values, length of hospital stay, and oxygen saturation values measured in the last polyclinic controls of our patients were compared according to the surgical characteristics of Fontan. Hand grip strength were measured, cardiopulmonary exercise tests and 6-minute walking tests were performed. In our study, it was determined that patients who underwent classical type Fontan surgery had a longer postoperative hospital stay compared to other surgical types, but no statistically significant difference was found (p=0,4778). The relationship between the measured oxygen saturation values according to the surgery type of Fontan was examined, the result was statistically significant (p=0,006). The type that made the difference was the lateral tunnel type which had higher oxygen saturations than other types. There was no significant difference between the extracardiac type and the intra-extracardiac type, the classical and extracardiac type, the intra-extracardiac type and the classical type (p=0,723, p=0,491, p=1,000, respectively). Hand grip strength was measured to evaluate skeletal muscle function, and no statistically significant difference was found between intra-extracardiac and extracardiac groups (p=0,152). A statistically significant positive correlation was found between the 6-minute walk test and the dominant hand grip strength (correlation coefficient: 0.543 *, p=0,13). In the future, larger groups of patients should be studied, according to the results, instead of the 6-minute walking test, the hand grip test, which can be easily applied in the outpatient clinic, can be performed. Exercise capacities were evaluated with estimated VO2max (ml/kg/min).The median estimated VO2max value in our patients was calculated as 35.6 mL/kg/min. Intra-extracardiac and extracardiac groups were compared according to VO2max values, there was no statistically significant difference between the groups (p=0,23). Body fat composition was evaluated and body fat ratios were found to be lower in the intra-extracardiac type than in the extracardiac type (p=0,038). We thought that in long term, having a lean body component might be associated with a better outcome in terms of prognosis and quality of life in patients who had undergone Fontan surgery. A statistically significant correlation was observed between lean body mass index (FFMI) and 6-minute walking test in our patients (correlation coefficient: 0.526 *, p=0,017).