Long-term cardiopulmonary exercise capacity after modified Fontan operation

Objective: Early circuit separation enhances the long-term success of Fontan haemodynamics. To test this hypothesis, we analysed the postoperative cardiopulmonary capacity in children and adults. Patients: Spiroergometry was performed at least twice in 43 patients with a median age of 14 (range: 7-43) years, with a median time interval of 4.6 (1.1-10.4) years between early and late testing. Twenty-eight patients had been operated on in childhood and 15 as adults. The exercise capacity (W_max) and oxygen consumption capacity (V O_{2 max}) were compared between children and adults. Results: The V O_{2 max} in children early postoperatively was better than in adults (median 27.9 vs 22.9, p = 0.032). Both V O_{2 max} (median 30.1 ml min^-1 kg^-1 vs 16.9 ml min^-1 kg^-1, p < 0.001), and W_max (median 2.2 W kg^-1 vs 1.4 W kg^-1, p < 0.001) were significantly better in children late after surgery. In the patient group as a whole, there was a significant decrease of V O_{2 max} between early and later testing (median 26.5 l min^-1 kg^-1 vs 20.7 l min^-1 kg^-1, p < 0.001). Conclusions: Fontan palliation in early childhood results in better cardiopulmonary capacity during long-term follow-up. Regular surveillance of the physical capacity by spiroergometry is indispensable for the supervision of patients with Fontan haemodynamics.