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Altitude affects long-term outcomes after Fontan procedure
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Living at a higher residential altitude appears to have a negative effect on long-term outcomes for patients who underwent a Fontan procedure.
Researchers reviewed clinical databases from a tertiary cardiac center at 5,000 feet elevation. The review included adult-age patients born between 1965 and 1991 with single ventricular anatomy who had a Fontan operation.
Joy T. Johnson
Patients were categorized into two groups: those with composite adverse outcome and those without composite adverse outcome, defined as death, cardiac transplantation, listing for cardiac transplantation or relocating to sea level to adjust for cardiac decompensation, according to the abstract.
The study included 149 patients with single-ventricle anatomy, of whom 103 underwent a Fontan operation, and 70 were adults living at moderate altitude. Researchers reported adverse outcomes in 55 patients, including death in 23%, cardiac transplantation in 17% and relocation to sea level due to clinical decompensation in 13%. Age, type or era of Fontan procedure played no role in long-term outcome, according to the study.
Patients who lived at altitude or lower residential altitude (4,296 feet vs. 4,637 feet, P<.001) and patients with lower pulmonary artery pressure before the Fontan procedure (13 mm Hg vs. 15 mm Hg, P=.01) and after (14 mm Hg vs. 18 mm Hg, P=.01) had better outcomes.
“We have identified risk factors for adverse outcome in this group of patients, including higher pulmonary artery pressures, lower oxygen saturations, presence of thrombosis or protein-losing enteropathy, and increased residential elevation,” Joy T. Johnson, MD, of the cardiology division in the department of pediatrics at Primary Children’s Medical Center, University of Utah, Salt Lake City, and colleagues wrote. “Presence of these other risk factors should prompt consideration of transplantation or a trial of living at sea level.”
Disclosure: The researchers report no relevant financial disclosures.
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