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Staehler H, Schaeffer T, Ruf B, Heinisch PP, Di Padua C, Burri M, Piber N, Hager A, Ewert P, Hörer J, Ono M. Impact of calorie intake and weight gain after Norwood procedure on the outcome of stage II palliation. Cardiol Young 2024; 34:876-883. [PMID: 37927221 DOI: 10.1017/s1047951123003736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND This study aimed to assess the impact of caloric intake and weight-for-age-Z-score after the Norwood procedure on the outcome of bidirectional cavopulmonary shunt. METHODS A total of 153 neonates who underwent the Norwood procedure between 2012 and 2020 were surveyed. Postoperative daily caloric intake and weight-for-age-Z-score up to five months were calculated, and their impact on outcome after bidirectional cavopulmonary shunt was analysed. RESULTS Median age and weight at the Norwood procedure were 9 days and 3.2 kg, respectively. Modified Blalock-Taussig shunt was used in 95 patients and right ventricle to pulmonary artery conduit in 58. Postoperatively, total caloric intake gradually increased, whereas weight-for-age-Z-score constantly decreased. Early and inter-stage mortality before stage II correlated with low caloric intake. Older age (p = 0.023) at Norwood, lower weight (p < 0.001) at Norwood, and longer intubation (p = 0.004) were correlated with low weight-for-age-Z-score (< -3.0) at 2 months of age. Patients with weight-for-age-Z-score < -3.0 at 2 months of age had lower survival after stage II compared to those with weight-for-age-Z-score of -3.0 or more (85.3 versus 92.9% at 3 years after stage II, p = 0.017). There was no difference between inter-stage weight gain and survival after bidirectional cavopulmonary shunt between the shunt types. CONCLUSION Weight-for-age-Z-score decreased continuously throughout the first 5 months after the Norwood procedure. Age and weight at Norwood and intubation time were associated with weight gain. Inter-stage low weight gain (Z-score < -3) was a risk for survival after stage II.
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Affiliation(s)
- Helena Staehler
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Bettina Ruf
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Chiara Di Padua
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Nicole Piber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Van den Eynde J, Westenberg JJM, Hazekamp MG, Lamb HJ, Jongbloed MRM, Wentzel JJ, Kenjeres S, Dekkers IA, Van De Bruaene A, Rijnberg FM, Roest AAW. Noninvasive Advanced Cardiovascular Magnetic Resonance-Derived Fontan Hemodynamics Are Associated With Reduced Kidney Function But Not Albuminuria. J Am Heart Assoc 2024; 13:e033122. [PMID: 38293946 PMCID: PMC11056124 DOI: 10.1161/jaha.123.033122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/01/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Kidney disease is the most important predictor of death in patients with a Fontan circulation, yet its clinical and hemodynamic correlates have not been well established. METHODS AND RESULTS A total of 53 ambulatory patients with a Fontan circulation (median age, 16.2 years, 52.8% male patients) underwent advanced cardiovascular magnetic resonance assessment, including 4-dimensional flow imaging and computational fluid dynamics. Estimated glomerular filtration rate (eGFR) <90 mL/min per 1.73 m2 was observed in 20.8% and albumin-to-creatinine ratio >3 mg/mmol in 39.6%. The average eGFR decline rate was -1.83 mL/min per 1.73 m2 per year (95% CI, -2.67 to -0.99; P<0.001). Lower eGFR was associated with older age, larger body surface area at examination, longer time since Fontan procedure, and lower systemic ventricular ejection fraction. Higher albumin-to-creatinine ratio was associated with absence of fenestration at the Fontan operation, and older age and lower systemic ventricular ejection fraction at the assessment. Lower cross-sectional area of the Fontan conduit indexed to flow (r=0.32, P=0.038), higher inferior vena cava-conduit velocity mismatch factor (r=-0.35, P=0.022), higher kinetic energy indexed to flow in the total cavopulmonary connection (r=-0.59, P=0.005), and higher total cavopulmonary connection resistance (r=-0.42, P=0.005 at rest; r=-0.43, P=0.004 during exercise) were all associated with lower eGFR but not with albuminuria. CONCLUSIONS Kidney dysfunction and albuminuria are common among clinically well adolescents and young adults with a Fontan circulation. Advanced cardiovascular magnetic resonance-derived metrics indicative of declining Fontan hemodynamics are associated with eGFR and might serve as targets to improve kidney health. Albuminuria might be driven by other factors that need further investigation.
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Affiliation(s)
- Jef Van den Eynde
- Department of Pediatrics, Division of Pediatric CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Congenital and Structural CardiologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Cardiovascular SciencesCatholic University LeuvenLeuvenBelgium
| | - Jos J. M. Westenberg
- CardioVascular Imaging Group, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Hildo J. Lamb
- CardioVascular Imaging Group, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Monique R. M. Jongbloed
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Anatomy & EmbryologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jolanda J. Wentzel
- Department of CardiologyBiomechanical Engineering, Erasmus MCRotterdamThe Netherlands
| | - Sasa Kenjeres
- Department of Chemical Engineering, Faculty of Applied SciencesDelft University of TechnologyDelftThe Netherlands
- J.M. Burgers Centrum Research School for Fluid MechanicsDelftThe Netherlands
| | - Ilona A. Dekkers
- CardioVascular Imaging Group, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Alexander Van De Bruaene
- Congenital and Structural CardiologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Cardiovascular SciencesCatholic University LeuvenLeuvenBelgium
| | - Friso M. Rijnberg
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Arno A. W. Roest
- Department of Pediatrics, Division of Pediatric CardiologyLeiden University Medical CenterLeidenThe Netherlands
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Möller T. Somatic growth in congenital heart disease-A balance between genetic potential and treatment effects. Acta Paediatr 2023; 112:178-179. [PMID: 36495100 DOI: 10.1111/apa.16613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Thomas Möller
- Department of Paediatric Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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